Association between Gray and White Matter Lesions and Its Involvement in Clinical Symptoms of Alzheimer's-Type Dementia

BACKGROUND

Not only gray matter lesions (GMLs) but also white matter lesions (WMLs) can play important roles in the pathology of Alzheimer's disease (AD). The progression of cognitive impairment (CI) and behavioral and psychological symptoms of dementia (BPSD) might be caused by a concerted effect of both GML and WML.

OBJECTIVE

This study aimed to investigate the association between GML and WML and how they are involved in the symptoms of CI and BPSD in dementia patients by means of imaging technology.

METHODS

Patients in our memory clinic, who were diagnosed with AD-type dementia or amnestic mild cognitive impairment (aMCI) and had undergone both single-photon emission computed tomography (SPECT) and brain MRI, were consecutively enrolled (n = 156; 61 males and 95 females; 79.8 ± 7.4 years old). Symptoms of CI and BPSD were obtained from patients' medical records. For the analysis of GMLs and WMLs, SPECT data and MRI T1-weighted images were used, respectively. This study followed the Declaration of Helsinki, and all procedures were approved by the institutional ethics committee.

RESULTS

According to a multivariate analysis, disorientation and disturbed attention demonstrated a relationship between the precuneus and WMLs in both hemispheres. Hyperactivity in BPSD showed multiple correlations between GMLs on both sides of the frontal cortex and WMLs. Patients with aMCI presented more multiple correlations between GMLs and WMLs compared with those with AD-type dementia regarding dementia symptoms including BPSD.

CONCLUSION

The interaction between GMLs and WMLs may vary depending on the symptoms of CI and BPSD. Hyperactivity in BPSD may be affected by the functional relationship between GMLs and WMLs in the left and right hemispheres. The correlation between GMLs and WMLs may be changing in AD-type dementia and aMCI.

Impact of hs-CRP concentration on brain structure alterations and cognitive trajectory in Alzheimer's disease

Introduction

Present study was to investigate hs-CRP concentration, brain structural alterations, and cognitive function in the context of AD [Subjective cognitive decline (SCD), mild cognitive impairment (MCI), and AD].

Methods

We retrospectively included 313 patients (Mean age = 76.40 years, 59 SCD, 101 MCI, 153 AD) in a cross-sectional analysis and 91 patients (Mean age = 75.83 years, 12 SCD, 43 MCI, 36 AD) in a longitudinal analysis. Multivariable linear regression was conducted to investigate the relationship between hs-CRP concentration and brain structural alterations, and cognitive function, respectively.

Results

Hs-CRP was positively associated with gray matter volume in the left fusiform (β = 0.16, pFDR = 0.023) and the left parahippocampal gyrus (β = 0.16, pFDR = 0.029). Post hoc analysis revealed that these associations were mainly driven by patients with MCI and AD. The interaction of diagnosis and CRP was significantly associated with annual cognitive changes (β = 0.43, p = 0.008). Among these patients with AD, lower baseline CRP was correlated with greater future cognitive decline (r = -0.41, p = 0.013).

Conclusion

Our study suggests that increased hs-CRP level may exert protective effect on brain structure alterations and future cognitive changes among patients already with cognitive impairment.

Impact of atrial fibrillation on the cognitive decline in Alzheimer's disease

BACKGROUND

Atrial fibrillation (AF) is a strong risk factor for Alzheimer's disease (AD) independent of ischemic stroke. However, the clinicopathological impact of AF on the severity of AD has not been well elucidated. We aimed to investigate the clinical differences between dementia patients with AF and those without AF by means of imaging data.

METHODS

Following approval from the institutional ethics committee, patients with newly diagnosed AD or amnestic mild cognitive impairment (aMCI) were retrospectively screened (n = 170, 79.5 ± 7.4 years old). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Based on the MRI data, the cerebral volume, cerebral microbleeds (CMBs), periventricular white matter lesions (WMLs), and deep WMLs were evaluated. The regional cerebral blood flow (rCBF) was measured using ¹²³I-IMP SPECT.

RESULTS

Of the patients, 14 (8.2%) and 156 (91.8%) had AF (AF group) and sinus rhythm (SR group), respectively. The AF group had significantly lower MMSE scores than the SR group (average [standard deviation (SD)]: 19.4 [4.4] and 22.0 [4.4], respectively; p = 0.0347). Cerebral volume and CMBs did not differ between the two groups. The periventricular WMLs, but not the deep WMLs, were significantly larger in the AF group than in the SR group (mean [SD] mL: 6.85 [3.78] and 4.37 [3.21], respectively; p = 0.0070). However, there was no significant difference in rCBF in the areas related to AD pathology between the two groups.

CONCLUSION

AD and aMCI patients with AF showed worse cognitive decline along with larger periventricular WMLs compared to those with SR, although the reduction of rCBF was not different between patients with AF and SR. The white matter lesions may be a more important pathology than the impairment of cerebral blood flow in dementia patients with AF. A larger study is needed to confirm our findings in the future.

Efficacy of a mixture of Ginkgo biloba, sesame, and turmeric on cognitive function in healthy adults: Study protocol for a randomized, double-blind, placebo-controlled trial

BACKGROUND AND PURPOSE

Ginkgo biloba extract (GBE) reportedly ameliorates cognitive function in patients with chronic cerebrovascular insufficiency. However, its efficacy in healthy adults is ambiguous. It was reported that concentrations of terpene lactones, active components of GBE that are present in very low concentrations in the brain, were significantly increased following administration of a mixture of GBE, sesame seed, and turmeric (GBE/MST) in mice. This study aims to investigate the effectiveness of GBE/MST on the cognitive function of healthy adults by comparing it with that of GBE alone.

METHODS

Altogether, 159 participants providing informed consent will be recruited from a population of healthy adults aged 20-64 years. Normal cognitive function at baseline will be confirmed using the Japanese version of the Montreal Cognitive Assessment battery. Participants will be randomly assigned in a double-blind manner to the GBE/MST, GBE, and placebo groups in a 1:1:1 ratio. The Wechsler Memory Scale, Trail Making Test, and Stroop Color and Word Test will be used to assess the memory and executive functions at baseline and at the endpoint (24 weeks). For biological assessment, resting state functional magnetic resonance imaging (rs-fMRI) will be performed simultaneously with the neuropsychological tests.

DISCUSSION

This study aims to obtain data that can help compare the profile changes in memory and executive functions among participants consuming GBE/MST, GBE alone, and placebo for 24 weeks. Alterations in the default mode network will be evaluated by comparing the rs-fMRI findings between baseline and 24 weeks in the aforementioned groups. Our results may clarify the impact of GBE on cognitive function and the functional mechanism behind altered cognitive function induced by GBE components.

TRIAL REGISTRATION

This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; registration number: UMIN000043494). This information can be searched on the website of the International Clinical Trials Registry Platform Search Portal of the World Health Organization under the Japan Primary Registries Network.

Impact of constipation on progression of Alzheimer's disease: A retrospective study

BACKGROUND AND PURPOSE

In terms of the gut-brain axis, constipation has been considered to be an important factor of neurodegenerative diseases, although the exact mechanism is still controversial. Herein, we aimed to investigate the contribution of constipation to the progression of dementia in a retrospective study.

METHODS

Patients of Alzheimer's disease(AD) and amnestic mild cognitive impairment were consecutively screened between January 2015 and December 2020, and those of whom brain MRI and neuropsychological tests were performed twice were enrolled in this study. Participants were classified into with constipation (Cons[+], n = 20) and without constipation (Cons[-], n = 64) groups. Laboratory data at the first visit were used. Regression analysis was performed in MMSE, ADAS-Cog, and the volumes of hippocampus on MRI-MPRAGE images and deep white matter lesions (DWMLs) on MRI-FLAIR images obtained at two different time points.

RESULTS

The main finding was that the Cons[+] group showed 2.7 times faster decline in cognitive impairment compared with the Cons[-] group, that is, the liner coefficients of ADAS-Cog were 2.3544 points/year in the Cons[+] and 0.8592 points/year in the Cons[-] groups. Ancillary, changes of DWMLs showed significant correlation with the time span (p < 0.01), and the liner coefficients of DWMLs were 24.48 ml/year in the Cons[+] and 14.83 ml/year in the Cons[-] group, although annual rate of hippocampal atrophy was not different between the two groups. Moreover, serum homocysteine level at baseline was significantly higher in the Cons[+] group than Cons[-] group (14.6 ± 6.4 and 11.5 ± 4.2 nmol/ml, respectively: p = 0.03).

CONCLUSION

There is a significant correlation between constipation and faster progression of AD symptoms along with expansion of DWMLs.

Perceived social isolation is correlated with brain structure and cognitive trajectory in Alzheimer’s disease

Both objective and perceived social isolations were associated with future cognitive decline and increase risk of Alzheimer’s disease (AD). However, the impacts of perceived social isolation depending on different clinical stages of AD have not been elucidated. The aim of this study was to investigate the influence of perceived social isolation or loneliness on brain structure and future cognitive trajectories in patients who are living with or are at risk for AD. A total of 176 elderly patients (mean age of 78 years) who had complaint of memory problems (39 subjective cognitive decline [SCD], 53 mild cognitive impairment [MCI], 84 AD) underwent structural MRI and neuropsychological testing. Loneliness was measured by one binary item question “Do you often feel lonely?.” Voxel-based morphometry was conducted to evaluate regional gray matter volume (rGMV) difference associated with loneliness in each group. To evaluate individual differences in cognitive trajectories based on loneliness, subgroup analysis was performed in 51 patients with AD (n = 23) and pre-dementia status (SCD-MCI, n = 28) using the longitudinal scores of Alzheimer’s Disease Assessment Scale-cognitive component-Japanese version (ADAS-Jcog). Whole brain VBM analysis comparing lonely to non-lonely patients revealed loneliness was associated with decreased rGMV in bilateral thalamus in SCD patients and in the left middle occipital gyrus and the cerebellar vermal lobules I − V in MCI patients. Annual change of ADAS-Jcog in patients who reported loneliness was significantly greater comparing to these non-lonely in SCD-MCI group, but not in AD group. Our results indicate that perceived social isolation, or loneliness, might be a comorbid symptom of patients with SCD or MCI, which makes them more vulnerable to the neuropathology of future AD progression.

Role of lymph node dissection in the treatment of urothelial carcinoma of the upper urinary tract: multi-institutional relapse analysis and immunohistochemical re-evaluation of negative lymph nodes

AIM

To determine the role of lymph node dissection (LND) in the treatment of urothelial carcinoma (UC) of the upper urinary tract (UUT).

PATIENTS AND METHODS

[Study-1] A retrospective multi-institutional study evaluated 293 patients undergoing predominantly nephroureterectomy for UC of the UUT. Of 293 patients, 267 patients had pure UC and 26 demonstrated other histological components. Regarding the pathological node status, 130 patients had pN0 disease, 141 patients had pNx disease and 22 patients had pN+ disease. The sites of initial recurrence and time to first recurrence were reviewed. The sites of recurrence were classified as locoregional or distant recurrence. The relationship between node status and future recurrence was analyzed. [Study-2] Fifty-one patients treated by nephroureterectomy at Hokkaido University Hospital were included. All had LND and all LNs were negative on hematoxylin and eosin staining. We re-evaluated the presence of micrometastasis in LND specimens by anti-cytokeratin immunohistochemistory.

RESULTS

[Study-1] Of 293 patients, 76 developed disease relapse. Regional lymph node recurrence was the most common site (34 patients). On multivariate analyses that adjusted for the effect of tumor stage and tumor grade, pNx (skipping LND) was an adverse factor not only for locoregional recurrence, but also for distant relapse. [Study-2] Immunohistochemistry identified micrometastases in 7 (14%) of 51 patients. Regarding survival, 5 of these 7 patients with micrometastases were alive at last follow-up.

CONCLUSIONS

On relapse analysis, skipping LND was an adverse factor not only for locoregional recurrence, but also for distant relapse. Immunohistochemistry detected micrometastases in about 14% of patients previously diagnosed as pN0. These findings further support a potential therapeutic benefit of LND by eliminating micrometastases.

Influence of environmental factors on IgE production

The prevalence of atopic diseases appears to have increased rapidly, especially in industrialized countries. The increase may be explained by a change in certain environmental factors. This article focuses on the influence of environmental factors on IgE production. Epidemiological or experimental reports have shown that tobacco smoke, virus infection and mercuric chloride may enhance IgE production. We demonstrated the enhancing effect of diesel-exhaust particulates (DEP), which seem to have increased in urban environments, on IgE antibody production. The IgE antibody responses in mice immunized by intraperitoneal injection of antigens mixed with DEP were higher than those in animals immunized with the antigens alone. DEP also had an adjuvant activity for IgE antibody production in mice after entry via the respiratory tract (the natural mode of entry). The enhancing effect of DEP on IgE antibody responses was demonstrated even when a small dose such as 1 micrograms of DEP was given intranasally at three-week intervals. Our further study has indicated that suspended particulate matter including materials other than DEP has an adjuvant activity for IgE antibody production.

Parental history of hypertension and cardiovascular responses to behavioral stress in young black women

Beta-adrenergic sympathetic nervous system (SNS) hyperresponsivity to behavioral stress may play a role in the onset of sustained high blood pressure--particularly in persons with a parental history of hypertension. Although hypertension is extremely prevalent among blacks, the association between parental history of hypertension and cardiovascular hyperresponsivity has not been explored in this group. The present study examined the influence of parental history of hypertension on cardiovascular stress reactivity in a group of young black females. Contrary to previous findings with whites, black subjects with a parental history of hypertension exhibited significantly smaller systolic blood pressure and forearm blood flow increases, and moderately smaller diastolic blood pressure increases to the task. Parental history subjects also exhibited slower heart rates throughout each experimental condition. The results suggest that blacks at risk from hypertension may not exhibit the beta-adrenergic hyperresponsivity to behavioral stress observed in whites. These results may suggest that beta-adrenergically mediated hyperresponsivity may be less involved in the development of hypertension among blacks.

Immunization against intestinal bacterial endotoxin prevents alcoholic fatty liver in rats

Accumulating evidences indicate that an endotoxin originating from intestinal gram-negative bacteria may be involved in alcohol-induced liver injury including fatty liver. Therefore, whether immunization against intestinal bacterial endotoxin blocked fatty liver induced by chronic alcohol and diet including much-unsaturated fatty acid was investigated in rats. The titer of antibody against the endotoxin increased significantly after 13 weeks of continuous immunization. Daily alcohol treatment was initiated at 12 weeks and continued for 4 weeks. Plasma glutamic pyruvic transaminase (GPT), glutamic oxaloacetic transaminase (GOT) and triglyceride (TG) levels increased significantly in non-immunized rats receiving alcohol, but not in immunized rats. Continuous alcohol treatment gradually decreased the survival rate to 60% from 13 days after beginning administration in non-immunized, but not immunized, rats. A histochemical study revealed that continuous treatment with alcohol and unsaturated fatty acids caused fatty liver in non-immunized, but not immunized, rats. This study strongly supports the hypothesis that alcohol-induced fatty liver is due to a circulating endotoxin, and suggests that immunization for endotoxin prevent the alcoholic fatty liver.

Versatility of the accessory C proteins of Sendai virus: contribution to virus assembly as an additional role

The P/C mRNA of Sendai virus (SeV) encodes a nested set of accessory proteins, C', C, Y1, and Y2, referred to collectively as C proteins, using the +1 frame relative to the open reading frame of phospho (P) protein and initiation codons at different positions. The C proteins appear to be basically nonstructural proteins as they are found abundantly in infected cells but greatly underrepresented in the virions. We previously created a 4C(-) SeV, which expresses none of the four C proteins, and concluded that the C proteins are categorically nonessential gene products but greatly contribute to viral full replication and infectivity (A. Kurotani et al., Genes Cells 3:111-124, 1998). Here, we further characterized the 4C(-) virus multiplication in cultured cells. The viral protein and mRNA synthesis was enhanced with the mutant virus relative to the parental wild-type (WT) SeV. However, the viral yields were greatly reduced. In addition, the 4C(-) virions appeared to be highly anomalous in size, shape, and sedimentation profile in a sucrose gradient and exhibited the ratios of infectivity to hemagglutination units significantly lower than those of the WT. In the WT infected cells, C proteins appeared to colocalize almost perfectly with the matrix (M) proteins, pretty well with an external envelope glycoprotein (hemagglutinin-neuraminidase [HN]), and very poorly with the internal P protein. In the absence of C proteins, there was a significant delay of the incorporation of M protein and both of the envelope proteins, HN and fusion (F) proteins, into progeny virions. These results strongly suggest that the accessory and basically nonstructural C proteins are critically required in the SeV assembly process. This role of C proteins was further found to be independent of their recently discovered function to counteract the antiviral action of interferon-alpha/beta. SeV C proteins thus appear to be quite versatile.

Spinal oligodendroglioma with diffuse arachnoidal dissemination in a Japanese Black heifer

A gelatinous focus with cystic spaces, was found in the posterior funiculus of the 2nd to 3rd lumbar levels of the spinal cord of a Japanese Black heifer, 2 years old, with clinical signs of severe dysstasia. Histopathological examination revealed that the spinal lesion consisted of multifocal and diffuse proliferation of round cells with abundant vacuolar cytoplasm and hyperchromatic nuclei. In the lesions there was a number of cystic spaces containing aggregates of small round cells. The neoplastic foci showed a honeycomb structure divided by thin blood vessels, representing typical lesions of oligodendroglioma. Diffuse and multifocal proliferation of these round cells were also recognized in the subarachnoidal space in the sacral spinal cord. Immunohistochemically, the proliferating round cells were negative for glial fibrillary acidic protein. Based on these morphological features, the case was diagnosed as lumbar spinal oligodendroglioma with diffuse arachnoidal dissemination.

Non-purulent meningoencephalomyelitis of a Pacific striped dolphin (Lagenorhynchus obliquidens). The first evidence of morbillivirus infection in a dolphin at the Pacific Ocean around Japan

On March 22, 1998, a mature, male, hyposthenic Pacific striped dolphin (Lagenorhynchus obliquidens) was stranded at Aoshima Beach in Miyazaki prefecture, Japan. A necropsy performed 14 hr after death revealed mild diffuse congestion and edema of the leptomeninges and mild pulmonary atelectasis. Histopathologically, non-purulent inflammatory were observed throughout the cerebrum, thalamus, midbrain, pons, medulla oblongata, and spinal cord. Hematoxylin and eosin stain revealed no viral inclusion bodies. Immunohistochemistry using a monoclonal antibody against nucleoprotein of canine distemper virus (CDV-NP) revealed a number of CDV-NP-positive granular deposits in the cytoplasm and cell processes of the degenerating or intact neurons. The present paper is a first report of spontaneously occurred morbillivirus infection in a dolphin at the Pacific Ocean around Japan.

Obui-himo syndrome

Normal variants of the venous system are relatively common and rarely cause severe symptoms. We report the case of a 5-month-old baby who displayed cyanotic color and swelling of arms whenever she was carried on the mother's back with a special band "Obui-himo". It was demonstrated by venography that the symptoms were caused by the absence of a cephalic vein and compression of axillary veins with the Obui-himo. In any country with a custom similar to the Obui-himo, these symptoms, if clinically encountered, are an indication that venography should be performed.

Cefotiam-induced IgE-mediated occupational contact anaphylaxis of nurses; case reports, RAST analysis, and a review of the literature

Cefotiam (CTM) is one of the most popular cephem antibiotics in Japan. Recently we experienced two cases of nurses with CTM-induced contact anaphylaxis. When they were preparing drip infusions of antibiotics or working around other nurses doing so, they suddenly fell into shock with other symptoms such as flushing, urticaria, abdominal distress, vomiting, dyspnoea and/or loss of consciousness. The symptoms never occurred after they avoided exposure to CTM. Passive cutaneous or open patch tests were positive for CTM. Histamine release was induced by CTM from washed leucocytes. RAST analysis using CTM-human serum albumin-coupled discs showed high % RAST count, suggesting that these reactions were mediated by IgE antibodies. A RAST inhibition test suggested that the methyl-thiotetrazole side-chain was the main antigenic determinant. Both patients had hand dermatitis that had appeared preceding the episodes of anaphylaxis. Although the dermatitis had been resistant to treatments, it also disappeared after they avoided exposure to CTM. It seemed likely that it was also induced or exacerbated by CTM and facilitated the penetration of CTM to cause anaphylaxis. The literature is also reviewed.

Impact of stress on serum gastrin in Zollinger-Ellison syndrome

We report an impressive case with Zollinger-Ellison syndrome (ZES), in which stress-induced sympathetic discharge influenced serum gastrin. Our patient was a 35-yr-old female who complained of frequent and massive vomiting (more than 4000 ml of gastric juice) which was aggravated especially by psychosocial stress. Basal hypergastrinemia (1900 pg/ml) was found after the admission. The most striking finding was that laboratory stress dramatically increased serum gastrin (from 1900 to 5400 pg/ml) and plasma noradrenaline (from 180 to 1130 pg/ml). Mental arithmetic stress further enhanced hypergastrinemia (5800 pg/ml) with a concomitant increase in plasma noradrenaline (1240 pg/ml). Neostigmine (10 micrograms/kg im) also increased serum gastrin up to 6100 pg/ml but propranolol (40 micrograms/kg i.v.) reduced these elevations (noradrenaline: 990 pg/ml, gastrin: 5000 pg/ml). In this case, the effect of stress on serum gastrin mimicked the effect of catecholamine infusion in ZES. These findings suggest that psychological stress induces serum gastrin secretion via beta-adrenoceptor with exacerbation of symptoms in some cases with ZES.

Brain-gut response to stress and cholinergic stimulation in irritable bowel syndrome. A preliminary study

To investigate the influence of the brain-gut interactions on the pathophysiology of irritable bowel syndrome (IBS), we compared such patients (n = 10) with healthy control subjects (n = 11) by measuring the pressure of the colon and small intestine simultaneously with analysis of power spectrum of the electroencephalography (EEG) under mental stress and administration of neostigmine. Stress slightly increased the colonic motility index, reduced the percentage of alpha power, and increased the percentage of beta and theta power of the EEG in the patients with IBS more than in the controls (p < 0.05). The patients with IBS had a longer phase II (p < 0.01) and shorter phase I (p < 0.02) of fasting duodenal motor activity than the controls. Neostigmine (10 micrograms/kg) caused a significant difference in the colonic motility index (p < 0.01) and power spectra of EEG (p < 0.05) in the patients with IBS compared to the controls. Significant positive correlation was detected between colonic motility and power spectral change induced by stress (r = 0.46, p < 0.05) or neostigmine (r = 0.51, p < 0.01). These results suggest that patients with IBS have exaggerated responsivity of the gut and the brain to mental stress and cholinergic stimulation. Moreover, there is a possibility that these exaggerated responses are related.

Case report: reversal of severe leukopenia by granulocyte colony-stimulating factor in anorexia nervosa

Recent attempts to reduce weight by patients with anorexia nervosa have sometimes led to life-threatening hematologic complications. This report describes an instance in which a patient with anorexia nervosa and pancytopenia drastically improved with treatment that included administration of granulocyte colony-stimulating factor. The patient had lost 27 kg of body weight within 8 months. Even after admission, the blood cell count continued to decrease rapidly as follows: platelet, from 244 x 10(3)/microliters to 44 x 10(3)/microliters; erythrocyte, from 4.04 x 10(6)/microliters to 2.58 x 10(6)/microliters; and leukocyte, from 4.8 x 10(3)/microliters to 1.6 x 10(3)/microliters (granulocyte, 0.8 x 10(3)/microliters). Complications included pneumomediastinum, pneumothorax, purpura, petechiae, hepatomegaly, fever, gangrenous stomatitis, and somnolence. Bone marrow aspiration disclosed absence of fat cells, marrow hypoplasia, and infiltration of the mature lymphocytes. Intravenous hyperalimentation, blood transfusion, gamma-globulin, and antibiotics were administered, but leukopenia and fever remained. However, administration of recombinant human granulocyte colony-stimulating factor dramatically reversed the leukopenia and fever. With careful nutrition therapy, the patient's blood cell count and bone marrow normalized by the time of discharge. It was concluded that severe hematologic disorders may occur in patients with anorexia nervosa, and advanced treatment may be required to save the patient's life.

[Brain-gut interactions in irritable bowel syndrome: physiological and psychological aspect]

Recent advances in the investigation of brain-gut interaction in irritable bowel syndrome (IBS) were reviewed. Brain is suggested to play an important role in the pathophysiology of IBS on the basis of the following evidence. (1) Stress often induces major symptoms of IBS patients (Drossman et al., 1982), simultaneously with colonic hypermotility (Fukudo et al., 1987) or dysmotility of the small intestine (Kumar et al., 1985). (2) IBS patients rarely express symptoms or small intestinal dysmotility during sleep (Kellow et al., 1990). (3) IBS patients complain of more pain with balloon distension of the colon or rectum than normal controls; visceral perception is enhanced in IBS (Whitehead et al., 1990). (4) IBS patients often show psychoneurotic symptoms and extra-colonic somatic symptoms (Young et al., 1976). (5) There are some animal (Williams et al, 1987) or human (Dinan et al, 1990) experiments which indicate the possible involvement of brain peptide or brain monoamine in IBS. (6) Dysrhythmia or increased beta power in electroencephalogram is observed more often in IBS patients than in the normal controls (Fukudo et al, 1991) in addition to abnormal REM sleep in IBS patients (Kumar et al., 1992). These observations support our hypothesis that not only the gut but also the brain show dysfunction and exaggerated responsivity to the stimuli in IBS. Further research on brain-gut interaction in IBS is warranted.

Accentuated vagal antagonism of beta-adrenergic effects on ventricular repolarization. Evidence of weaker antagonism in hostile type A men

BACKGROUND

Prior research has suggested a weaker parasympathetic antagonism of sympathetic effects on the heart in type A (coronary-prone) men. To confirm this phenomenon and extend our understanding of it, we investigated the effects of prior muscarinic blockade on the electrocardiogram T wave and other cardiovascular and neuroendocrine responses to isoproterenol in type A and type B (non-coronary-prone) men.

METHODS AND RESULTS

Responses to two 5-minute intravenous isoproterenol infusions (0.01 micrograms/kg/min and 0.02 micrograms/kg/min) were evaluated in six type A and six type B men after pretreatment with either dextrose placebo or atropine (1.2 mg). Atropine significantly potentiated T wave attenuation in the recovery period after isoproterenol infusion (0.30 +/- 0.07 mV) compared with placebo (0.54 +/- 0.09 mV, p less than 0.001). Atropine also potentiated the heart rate increase to isoproterenol (39 +/- 3 beats per minute versus 20 +/- 2 beats per minute after placebo). Atropine enhanced decreases in systolic, diastolic, and mean arterial pressures as well as pulse pressure to isoproterenol. Atropine enhancement of many of these responses was increased among subjects with high scores on various hostility/anger scales. Isoproterenol alone produced greater T wave attenuation in type A than in type B men. However, atropine enhancement of T wave attenuation and blood pressure falls by isoproterenol was present only in type B men.

CONCLUSIONS

These findings indicate that there is accentuated parasympathetic antagonism of T wave attenuation and blood pressure responses induced by beta-adrenergic stimulation. Relative weakness of this antagonism of sympathetic effects on the heart in hostile type A individuals may contribute to their higher coronary disease risk.

Topical thrombin-induced IgE-mediated anaphylaxis: RAST analysis and skin test studies

Bovine topical thrombin (BTT) is a heterologous plasma thrombin concentrate that has been frequently used for the hemostasis since the 1940s. Recently, three patients in Japan went into shock after the topical application of BTT at lesion sites, and two of these patients had received BTT repeatedly. The clinical symptoms and the increased anti-BTT percent RAST counts suggest that these reactions were shock mediated by anti-BTT IgE antibodies. The RAST-inhibition analysis suggested that the antigenic substance(s) were bovine-specific moiety(ies) mainly involved in the contaminant rather than bovine thrombin itself. The skin tests were studied to predict such allergic reactions. The intracutaneous test provoked nonspecific reactions even at the low concentrations of BTT. The prospective study on the predictive value of the prick test with 1000 U/ml (1 mg/ml) of BTT in 192 patients suggested that it is useful to detect highly sensitive patients. In addition, the increased levels of anti-BTT IgE antibodies in patients 1 month after the single administration of BTT suggested the immunogenicity of the topical application of BTT.

Beta and alpha adrenergic reactivity elicitable stress study with special reference of electrocardiographic T-wave amplitude

Twenty-six healthy young Caucasian males were defined into high hostile (Hi-Ho) group and low hostile (Lo-Ho) group assessed by Cook-Madley's Hostility (Ho) scale. Mental arithmetic task (MA) and forehead cold stimulus task (FCS) were loaded to both Hi-Ho and Lo-Ho groups. Electrocardiographic T-wave amplitude (TWA), heart rate (HR) and coefficient of variance of 100 R-R intervals (CVR-R) were measured continuously during MA and FCS task periods. Greater TWA attenuation was found in Hi-Ho group (p less than 0.05). Although no significant intergroup difference was represented in HR and CVR-R, HR increased significantly (p less than 0.01) in whole subjects and CVR-R was tend to be suppressed during MA period. In addition, comparison of these physiological responses were performed between Type-A and Type-B groups classified by Jenkins' Activity Survey Form-T (JAS-T). There was no significant difference in reactivity of TWA, HR and CVR-R to both two tasks between high and low Type-A scored groups. Previous data suggested that the TWA reactivity in Hi-Ho subjects to cognitive stress showed similar pattern in Type-A individuals. However, autonomic nervous interaction could not be clarified in Hi-Ho subjects. The differentiation of method for assessment of behavioral pattern was also discussed.

Enhancing effect of suspended particulate matter on the IgE antibody production in mice

Suspended particulate matter (SPM), suspended in the polluted environmental atmosphere, are perpetually inhaled into the human body and are considered to have profound effects on human health. This study investigated the enhancing effect of SPM on the IgE antibody production in mice. The IgE antibody responses in mice immunized with intranasal administration of ovalbumin (OA) plus SPM at 3-week intervals were higher than responses in the animals immunized with OA alone. When the dose of OA administered as an antigen was 0.25 microgram, the time course and magnitude of enhancement by SPM was comparable to those by killed Bordetella pertussis, a common adjuvant. SPM had an enhancing effect on IgE antibody production even in a small dose such as 0.25 microgram administered at 3-week intervals. The possibility cannot be excluded that the natural exposure of humans to SPM in the environmental atmosphere may explain the high prevalence rate of allergic rhinitis caused by pollens in polluted districts in Japan.

Racial differences in blood pressure and forearm vascular responses to the cold face stimulus

The mechanisms responsible for the higher incidence of essential hypertension in blacks than in whites are the object of much research attention. One hypothesis is that the development of hypertension in blacks is associated with exaggerated blood pressure reactivity, particularly those responses mediated by vasoconstriction. Racial differences in blood pressure responses to cold stimulation of the forehead, a known alpha-adrenergic vasoconstrictive stimulus, were examined in health, college-age males. Compared to white subjects, black subjects exhibited significantly greater increases in systolic and diastolic blood pressure, as well as increases in forearm vascular resistance, in response to cold stimulation. This preliminary evidence of increased peripheral vascular reactivity in blacks suggests that known racial differences in hypertension prevalence might derive in part from physiological differences in sympathetic nervous system reactivity.

Diesel-exhaust particulates inoculated by the intranasal route have an adjuvant activity for IgE production in mice

Our previous study indicated that the IgE antibody responses in mice immunized with intraperitoneal injection of the antigens mixed with diesel-exhaust particulates (DEP) were higher than those in the animals immunized with the antigens alone. We examined the adjuvant activity of DEP inoculated by the intranasal route, i.e., the natural entrance of DEP. In 3-week interval immunization, the IgE antibody responses in mice immunized with intranasal inoculation of ovalbumin (OA) mixed with DEP were higher than responses in the animals immunized with OA alone. DEP had an adjuvant activity for anti-OA IgE antibody production, even in a small dose such as 1 micrograms administered with a 3-week interval. Also in 1-week interval immunization, the enhancing effect of DEP on anti-OA IgE antibody production was demonstrated when mice were immunized with intranasal inoculation of OA and DEP. The possibility cannot be excluded that DEP, which are kept buoyant in the environmental atmosphere of urban districts, may exert an adjuvant activity for IgE antibody production after being inhaled into the human body and have some relation to the mechanism of the outbreak of allergic rhinitis caused by pollens in Japan.

Enhanced endothelial cell proliferation in acute Kawasaki disease (muco-cutaneous lymph node syndrome)

Paired sera from 30 patients with muco-cutaneous lymph node syndrome (Kawasaki disease) were studied for possible effects on human vascular endothelial cells growth in vitro. The majority of sera from acute phase muco-cutaneous lymph node syndrome patients significantly enhanced endothelial cell proliferation more than those from convalescent phase patients, infectious diseases patients, and age-matched normal controls. This stimulation was considered to be specific for EC since muco-cutaneous lymph node syndrome sera did not enhance fibroblast growth more than normal sera. Fractionation of the serum with gel filtration failed to clearly detect the molecular properties of this effect, although both heavy and light material possessed this activity. Extensive search for circulating immune complex in muco-cutaneous lymph node syndrome sera were negative, suggesting that the enhanced endothelial cell proliferation was due to serum components other than immune complexes.

Adjuvant activity of diesel-exhaust particulates for the production of IgE antibody in mice

The prevalence rate of allergic rhinitis caused by pollen has strikingly increased in Japan in the last three decades. The number of diesel cars in use has also rapidly increased in the country. This fact urged us to study the effects of particulates emitted from diesel cars on the production of IgE antibody. The primary IgE antibody responses in mice immunized with intraperitoneal injection of ovalbumin (OA) mixed with diesel-exhaust particulates (DEP) were higher than those in the animals immunized with OA alone. This effect of DEP on the production of IgE antibody in mice was also demonstrated when mice were immunized with repeated injections of dinitrophenylated-OA. In addition, persistent IgE-antibody response to major allergen of Japanese cedar pollen (JCPA), a most common pollen causing allergic rhinitis in Japan, was observed in mice immunized with JCPA mixed with DEP but not in the animals immunized with JCPA alone. The results do indicate that the adjuvant activity of DEP can not be excluded as a possible cause of the associated change in the number of diesel cars and allergic rhinitis caused by pollen in Japan.

IgE antibody-mediated shock reaction caused by topical application of chlorhexidine

A case of an anaphylactic shock following topical application of chlorhexidine preparation is reported. Specific skin-sensitizing antibodies against chlorhexidine were demonstrated in the serum from the patient by a passive transfer test. IgE antibodies against chlorhexidine were also detected by radioallergosorbent technique (RAST). Paper discs conjugated with chlorhexidine-HSA (human serum albumin) significantly bound the IgE antibodies. Furthermore, all of the sera from seven other patients with shock reactions following the topical application of chlorhexidine preparation also showed high RAST counts. Both chlorhexidine gluconate and chlorguanide which represents approximately half a molecule of chlorhexidine inhibited the reaction in a dose-dependent fashion. It is suggested that the shock reactions following topical application of chlorhexidine are mediated by IgE antibodies against chlorhexidine and that chlorhexidine and chlorguanide share the same antigenic determinant.

Chromatographic separation and chemical analysis of polymers formed by penicillin G

To elucidate the chemical structures of penicillin polymers that may elicit an allergic reaction, a 25% aqueous solution of penicillin G potassium was kept standing in the dark at room temperature for 14 days and was then separated by gel filtration chromatography on Sephadex G-25. The fractions of Kav 0.0-0.3, 0.3-0.55 and 0.55-0.75 were designated fractions A, B and C, respectively. Chemical and spectral data indicated that fractions A and B had almost similar chemical structures, but differed in molecular weight. They consisted of equimolar phenylacetyl and thiazolidine moieties and showed a C:N:S ratio almost equal to that of penicillin G. Their degrees of polymerization were 10 for A and 3.2 for B. Comparison of 1H NMR and IR spectra and thin-layer chromatographic RF values with those of authentic standards showed that the main components of fraction C were N- formylpenicillamine , benzylpenilloic acid, benzylpenicilloic acid and benzylpenillic acid.

[Studies on the skin test of cefotiam and anti-cefotiam antibody]

Patients having previously not received cefotiam (CTM), a recently introduced cephem antibiotic, were subjected to skin tests with a 300 micrograms/ml solution of CTM in physiological saline before and after CTM therapy to detect sensitization with the drug. Anti-CTM antibody titration was carried out on sera from patients who showed a positive skin test and those who developed signs of hypersensitivity during CTM therapy. The results were as follows: Of 1,927 patients examined by skin test with CTM prior to initiation of CTM therapy, 31 patients (1.61%) showed positive reactions with formation of a wheal and erythema. There were 7 patients (0.36%) who proved negative in the skin test but developed mild symptoms of hypersensitivity in association with the skin test. The 847 patients negative on the CTM skin test were retested after a completion of CTM therapy, of whom 6 (0.71%) were found to have become positive showing formation of a wheal and erythema and 3 others (0.35%) showing a negative skin test developed mild adverse reactions associated with the skin test. Sixty-eight serum samples collected from the patients positive on the CTM skin test and those who developed manifestations of hypersensitivity following CTM therapy were examined for anti-CTM antibody by the Prausnitz-K ustner reaction, passive cutaneous anaphylaxis test and hemagglutination test. All proved negative in these tests. Of various background factors assessed, none was found to have causal relation to the skin reaction in any of the patients showing positive skin reactions to CTM.

Studies on safety problem by skin tests using human beta interferon preparation

Skin reactivities to human fibroblast-derived interferon (HuIFN-beta) preparation were studied in 20 healthy subjects in order to establish a method that detects hypersensitivity to the preparation. In response to intracutaneous injection of 0.02 ml of a 3 X 10(6) international reference units (IU)/ml of HuIFN-beta, the subjects developed immediate wheal-and-erythema type cutaneous reactions followed by erythemas maximum in diameter at 12 and 48 h. The immediate reactions were macroscopically similar to those observed in IgE-mediated cutaneous allergic reactions were macroscopically similar to those observed in IgE-mediated cutaneous allergic reactions elicited by intradermal injection of allergens. Little or no such reactions occurred with test solutions in concentration of less than 2 X 10(5) IU/ml and with solutions containing proteins of bovine origin, possible contaminants of the proteins in the preparation. These results suggest that the immediate cutaneous response to the solution of 3 X 10(6) IU/ml of HuIFN-beta is an essentially nonspecific reaction to HuIFN-beta or substances intimately associated with HuIFN-beta. For prediction of IgE-mediated hypersensitivity, a skin test with a solution containing HuIFN-beta in concentration of less than 2 X 10(5) IU/ml seems to be applicable. A test with a solution containing neonatal calf serum in concentration of 10-100 micrograms/ml may also be necessary as well as with the HuIFN-beta preparation.

Eliciting IgE-mediated passive cutaneous anaphylactic reaction by synthetic D-benzylpenilloic acid analogs

The ability of various D-benzylpenilloic acid analogs to evoke the passive cutaneous anaphylactic (PCA) reaction was tested in rats sensitized with mouse IgE antibodies to a benzylpenicillin preparation. D-benzylpenilloic acid synthesized chemically from materials that had no potency to evoke the PCA reaction showed almost the same antigenicity in eliciting the reaction as that prepared from benzylpenicillin. Changes in the chemical structures of the side-chain and thiazolidine ring of D-benzylpenilloic acid resulted in a reduction in the activity, but the removal of either alpha- or beta-methyl did not greatly affect it. From these results, it was concluded that benzyl and amidomethyl at C-2, the D-configuration at C-4, and dimethyl at C-5 on the thiazolidine ring have a significant effect on the PCA reaction.

Gold-induced reduction in reactivity to histamine in isolated guinea pig tracheal rings

Direct effects of gold preparations on the smooth muscle were investigated on isolated guinea pig tracheal rings. Pretreatment of the tracheal rings for 150 min with 100 microM of gold sodium thiomalate [Au(I)] significantly reduced the contraction heights induced by 4.5 microM histamine from 0.24 +/- 0.02 to 0.14 +/- 0.01 g (p less than 0.01). Gold chloride [Au(III)] was far more potent in its inhibitory effects than gold sodium thiomalate. With 15 min preincubation, gold chloride significantly suppressed the histamine-induced contraction (p less than 0.05) at such a low concentration as 10 microM (3.4 micrograms/ml). Gold chloride as well as gold sodium thiomalate did not interfere with the ciliary motion of the tracheal epithelium, whereas colchicine, having no effect on the histamine-induced contraction, did interfere with ciliary motion. These results reveal that gold itself inhibits noncaustically the guinea pig tracheal contraction induced by histamine.

[Clinical evaluation of cefotaxime in internal medicine]

Cefotaxime (CTX) was used for 129 cases in respiratory tract and other infections; 57 cases of pneumonia, 20 cases of bronchopneumonia, 20 cases of acute bronchitis, 14 cases of chronic bronchitis, 7 cases of acute exacerbation of bronchiectasia or pulmonary emphysema, 4 cases of suppurative diseases of the lung, 1 case of pyothorax, 1 case of retropharyngeal abscess, 3 cases of pleurisy and 1 case of urinary tract infection. (A case was excepted on clinical evaluation.) CTX was administered by intravenous injection or drip infusion at a daily dose ranging from 0.5 to 8 g, for a term of 2 to 61 days. The total dose patients received ranged from 3 to 226 g. The results obtained were as follows. Clinical effects; excellent in 45 cases, good in 63 cases, fair in 9 cases, poor in 7 cases and unevaluable in 4 cases. The efficacy rate was 87.1% (108/124). Bacteriological effects; eliminated in 30 cases, decreased in 8 cases, unchanged in 2 cases and replaced in 1 case. The elimination rate was 75.6% (31/41). Side effects and abnormal laboratory findings; general itching, fatigue in lower extremities and albuminuria in 1 case each, and anemia in 2 cases. Increased number of eosinophiles and elevated GOT in 1 case each, elevated GOT and GPT in 3 cases and elevated GOT, GPT and A1-P in 2 cases. These symptoms or abnormal laboratory findings disappeared after the discontinuation or termination of CTX therapy. In view of the above, CTX may be considered to be a clinically useful antibiotic against respiratory tract infections.

Contraction of guinea pig trachea with antibodies to guinea pig IgE. An in vitro model for asthma

Rabbit antiserum to guinea pig IgE was prepared. This antiserum absorbed IgE antibodies to dinitrophenyl determinants when examined by passive cutaneous anaphylaxis. This antiserum also provoked contraction of tracheal rings from normal guinea pigs in vitro. This system is a new model for asthma in which only IgE among immunoglobulins reacts.

Bronchial responsiveness to acetylcholine in patients with bronchial asthma after long-term treatment with gold salt

Three groups of adult patients with bronchial asthma were subjected to long-term chrysotherapy (gold therapy), immunotherapy, or symptomatic therapy. Five of 14 patients who were treated with repeated injections of gold salt entered a symptom-free state that continued for more than 3 yr without the use of any bronchodilators or corticosteroids. In the other groups, there were no patients who entered such a state of long-term remission during the treatment. A statistically significant decrease in the bronchial responsiveness to inhaled acetylcholine was also observed in patients who received chrysotherapy. In the other groups, there were no significant differences between the bronchial responsiveness to acetylcholine that was estimated before the treatment and that measured after long-term treatment. Long-term chrysotherapy in the asthmatic patients did not reduce their serum level of total IgE. Gold salt, which is generally accepted as an antirheumatic drug, has also been used as an antiasthmatic drug by some Japanese practitioners despite the absence of evidence to support the therapeutic effect of the drug on asthma; the results of the study provide more information on the treatment of bronchial asthma with gold therapy.

Antigenicity of semisynthetic penicillin preparations to evoke systemic anaphylactic reactions in animal models

Four commercially available penicillin preparations (benzylpenicillin, aminobenzylpenicillin, carbenicillin and sulbenicillin) and two kinds of the new semisynthetic penicillin preparations (mezlocillin and piperacillin) evoked systemic anaphylactic reactions in guinea pigs immunized with one of the following penicillin-Ascaris extract (As) conjugates in aluminum hydroxide gel (alum), i.e., benzylpenicilloyl (BPO)-As, aminobenzylpenicilloyl (ABPO)-As, carbenicilloyl (CBPO)-As, sulbenicilloyl (SBPO)-As, mezlocillin-As conjugate (MEZ-As) and piperacillin-As conjugate (PIP-As). The tracheal chains prepared from the tracheas of the guinea pigs immunized with BPO-As, MEZ-As, or PIP-As revealed anaphylactic contractions in vitro on addition of benzylpenicillin, mezlocillin, or piperacillin preparations. These results indicated that the semisynthetic penicillin preparations as well as benzylpenicillin preparation have enough antigenicity to evoke systemic anaphylactic reactions in guinea pigs immunized with penicillin-As conjugate. Such guinea pigs seem to be suitable animals for investigations of penicillin allergy.

Clinical evaluation of a new orally active anti-anaphylactic compound: ketotifen (HC 20-511) in Japanese adult asthmatics

The protective effect of ketotifen was examined by an open assessment trial in 261 asthmatics of variable types, a double blind trial comparing ketotifen and inert placebo in 189 asthmatics of extrinsic type including pure atopic asthma and asthma with atopic and infectious components (mixed type or combined type), and a double blind trial comparing ketotifen and disodium cromoglycate (DSCG) by double placebo technique in 132 asthmatics of a pure atopic type. The open clinical assessment trial suggested that ketotifen was most effective in atopic asthmatics having moderate and severe as well as mild asthmatic episodes. Efficacy increased with prolonged administration; 1 mg twice daily was better than a 1 mg daily dose. In the placebo-controlled double blind trial, the efficacy of ketotifen was demonstrated by the reduction of concomitant anti-asthmatic therapy. The results of the double blind trial comparing ketotifen and DSCG are not fully reported. However, preliminary data showed that the efficacy of both drugs was equivalent or that ketotifen was slightly superior to DSCG. Safety of ketotifen was confirmed by the three trials, transient day-time sedation being the major side effect of this agent. In conclusion, ketotifen is a promising drug for the prophylaxis of asthma.