Range of motion exercise of temporo-mandibular joint with hot pack increases occlusal force in patients with Duchenne muscular dystrophy

The purpose of this study is to evaluate whether the range of motion exercise of the temporo-mandibular joint (jaw ROM exercise) with a hot pack and massage of the masseter muscle improve biting disorder in Duchenne muscular dystrophy (DMD). The subjects were 18 DMD patients (21.3+/- 4.1 years old). The jaw ROM exercise consisted of therapist-assisted training (2 times a week) and self-training (before each meal every day). The therapist-assisted training consisted of the application of a hot pack on the cheek of the masseter muscle region (15 minutes), the massage of the masseter (10 minutes), and jaw ROM exercise (5 minutes). The self-training involved jaw ROM exercise by opening the mouth to the maximum degree, ten times. These trainings continued for six months. Outcomes were evaluated by measuring the greatest occlusal force and the distance at the maximum degree of mouth opening between an incisor of the top and that of the bottom. Six months later, the greatest occlusal force had increased significantly compared with that at the start of jaw ROM exercise (intermediate values: from 73.8N to 97.3N) (p = 0.005) as determined by the Friedman test and Scheffi's nonparametric test. The patients' satisfaction with meals increased. However, the maximum degree of mouth opening did not change after six months of jaw ROM exercise. Jaw ROM exercise in DMD is effective for increasing the greatest occlusal force.

Isolation and characterization of native Cry j 3 from Japanese cedar (Cryptomeria japonica) pollen

BACKGROUND

Japanese cedar (Cryptomeria japonica) pollinosis is the most prevalent allergy in Japan. Recently, the Japanese cedar pollen allergen Cry j 3 was cloned as a homologue of Jun a 3, which is a major allergen from mountain cedar (Juniperus ashei) pollen. However, native Cry j 3 has not been isolated and there are no reports on its allergenic activity. The aims of this study were to isolate native Cry j 3 and assess its immunoglobulin E (IgE)-binding capacity in patients with Japanese cedar pollinosis.

METHODS

Native Cry j 3 was purified from Japanese cedar pollen by multidimensional chromatography. We assessed the IgE-binding capacity using sera from patients allergic to Japanese cedar pollen by immunoblot analysis and ELISA. Moreover, we assayed the capacity of Cry j 3 to induce histamine release from the patients' leukocytes. We cloned cDNA corresponding to purified Cry j 3 from a cDNA library of Japanese cedar pollen.

RESULTS

We isolated native Cry j 3 as a 27-kDa protein. The IgE-binding frequency of Cry j 3 from the sera of patients allergic to Japanese cedar pollen was estimated as 27% (27/100) by ELISA. Cry j 3 induced the release of histamine from leukocytes. We cloned the cDNA and named it Cry j 3.8. Cry j 3.8 cDNA encoded 225 amino acids and had significant homology with thaumatin-like proteins.

CONCLUSIONS

Cry j 3 is a causative allergen in Japanese cedar pollinosis and may play crucial roles in the cross-reactivity with oral allergy syndrome.

Characterization of genes for a pollen allergen, Cry j 2, of Cryptomeria japonica

BACKGROUND

Cry j 2 is one of the major pollen allergens of Cryptomeria japonica. The polymorphism of Cry j 2 isoforms and the conservation of the structure of Cry j 2 in coniferous species remain to be analyzed.

METHODS

A cDNA library derived from the pollen of C. japonica was screened using a fragment of Cry j 2 cDNA. Restriction fragment length polymorphism analysis was performed to examine the diversity of Cry j 2 genes. The promoters of Cry j 2 genes were isolated with a commercially available cloning kit. Clonal variations in the expression of Cry j 2 in pollen were examined by RNA gel blot analysis, and the conservation of the structure of the Cry j 2 gene in coniferous species was evaluated by DNA gel blot analysis.

RESULTS

We isolated three cDNA clones encoding novel isoforms of Cry j 2. We also sequenced a total of 16 promoter regions from 10 specimens. The sequences of promoter regions of Cry j 2 genes were highly divergent. The amount of Cry j 2 mRNA also varied considerably. The Cry j 2 gene was found to be conserved among species belonging to Taxodiaceae and Cupressaceae but to vary between Taxodiaceae and Pinaceae.

CONCLUSIONS

The coding and promoter regions of Cry j 2 genes contain large numbers of polymorphisms. Our analysis revealed large variations in the expression of Cry j 2 at the transcriptional level, and we suggest that conserved homologs of Cry j 2 confer cross-allergenicity among Taxodiaceae and Cupressaceae.

Frequency of spinocerebellar ataxia mutations in the Kinki district of Japan

OBJECTIVES

To determine the frequencies of spinocerebellar ataxias (SCAs) in the Kinki district, the western part of the main island of Japan.

MATERIAL AND METHODS

One hundred and forty-three families with dominantly inherited ataxia and 220 patients with apparently sporadic cerebellar ataxia were examined for the SCA1, SCA2, SCA3/Machado-Joseph disease (MJD), SCA6, SCA7, SCA8, SCA12 and dentatorubral-pallidoluysian atrophy (DRPLA) mutations.

RESULTS

Among the dominant families, SCA1 accounted for 3%, SCA2 for 4%, SCA3/MJD for 24%, SCA6 for 31% and DRPLA for 12%. Neither SCA7 nor SCA12 mutations were detected. Among the apparently sporadic patients, 15% were found to have expanded triplet repeats. Of these, the SCA6 mutation was most frequently detected.

CONCLUSION

SCA6 is the most common SCA in the Kinki district of Japan. Comparison of our results with those from other regions of Japan and different countries shows geographic and ethnic variation in the frequency of SCAs.

Comparison of piezo-assisted micromanipulation with conventional micromanipulation for intracytoplasmic sperm injection into human oocytes

OBJECTIVE

To compare the efficacy of piezo-assisted micromanipulation with conventional micromanipulation for intracytoplasmic sperm injection (ICSI) into oocytes in patients with impaired semen parameters and no success with in vitro fertilization (IVF).

STUDY DESIGN

A retrospective randomized study was conducted on 204 cycles for 104 couples with piezo-assisted ICSI and 122 cycles for 96 couples with conventional ICSI. Piezo-assisted ICSI consists of two steps, namely penetration of the zona pellucida alone with a piezo-pulse and then puncturing of the oolemma with a light negative pressure without piezo, as with conventional ICSI. The tips of injection pipettes were prepared after pulling by breakage with a scalpel under a microscope, so that the inner diameter at and near the tip was 5 microm, as for conventional ICSI.

RESULTS

Piezo-assisted ICSI demonstrated significantly more favorable results, with a fertilization rate of 90.3% (conventional ICSI: 83.1%, p < 0.01) and a cleavage rate of 88.1% (conventional ICSI: 84.6%, p < 0.01).

CONCLUSION

Piezo-assisted ICSI is easy to incorporate a spermatozoa exactly into the ooplasm with little deformation of the oocyte during insertion. Piezo-assisted ICSI can be used effectively for human oocytes to improve the fertilization, cleavage rates.

Ancestral MADS box genes in Sugi, Cryptomeria japonica D. Don (Taxodiaceae), homologous to the B function genes in angiosperms

In flowering plants, flower organ identity is controlled by the ABC genes, including several MADS box genes. We present two MADS box genes of a conifer, Cryptomeria japonica D. Don. The genes, CjMADS1 and CjMADS2, were related to the angiosperm B function genes which determine the identities of petals and stamens. A phylogenetic analysis showed that these genes form a new clade outside the angiosperm B group, that is, PISTILLATA (PI) and APETALA3 (AP3) lineages. CjMADS1 had a PI-group specific motif and CjMADS2 had AP3-group specific motifs at the C terminal end, respectively. CjMADS1 was expressed in male strobili (or cones) throughout its development, while CjMADS2 was transiently expressed during male strobilus development. The specific expression in the male reproductive organ indicated that the B function is maintained in gymnosperms. Our cladistic analysis suggests that the gene duplication event which generated B function gene lineages predates the divergence of angiosperms and gymnosperms and that the gene duplication which produced the two genes of C. japonica occurred in an ancestral conifer species.

Quantitative study of changes in intestinal morphology and mucus gel on total parenteral nutrition in rats

Quantification of changes in gastrointestinal morphology and mucus gel has been difficult to study. In the present study, we investigated changes in rat intestine under total parenteral nutrition (TPN) using fluoresceinated lectin staining and image analysis. Wistar rats (n = 34) were divided into two groups: one group received TPN for 2 weeks, and a control group received standard rat chow and water ad libitum for the same period. A 1-cm segment of distal ileum was removed and cut into cross sections. Sections were stained with hematoxylin and eosin, and to stain the mucus, periodic acid-Schiff (PAS), alcian blue (AB), and fluoresceinated lectin, that is, FITC-labeled Ulex europaeus agglutinin I (FITC-UEA-I), were used. Light microscope images were stored in a personal computer and analyzed using image analysis. We measured perimeter length, mucosal thickness, villus area, villus surface area index, mucus stain-positive area, mucosal area ratio, and mucosal surface area ratio. Perimeter length, mucosal thickness, villus area, and villus surface area index in the TPN group were significantly less than those in the control group (P < 0.001 for each parameter). In all mucus stainings, the stain-positive area in the TPN group was significantly less than that in the control group. However, there were no significant differences in mucosal area or mucosal surface area ratios between the two groups. The FITC-UEA-I-positive area was significantly greater than the PAS- or and AB-positive area. There were significant positive correlations between the FITC-UEA-I-positive area and both the PAS-positive and AB-positive areas. TPN for 2 weeks promoted intestinal atrophy and decreased absolute quantity of mucus gel. We successfully introduced the FITC-UEA-I staining method to evaluate changes in mucus gel.

Clinicopathologic significance of sialyl Le(x) expression in advanced gastric carcinoma

Sialyl Lewis(x)antigen (SLX) is a carbohydrate antigen that serves as a ligand for selectin, an adhesion molecule expressed on vascular endothelial cells. The expression of SLX in 245 patients with advanced gastric carcinoma was examined immunohistochemically, and its clinicopathologic significance was analysed. We classified the patients with advanced gastric carcinoma into 91 with differentiated type and 154 with undifferentiated type. SLX expressed in 135 of 245 patients (55%), comprising 68 (75%) patients with differentiated carcinoma and 67 (44%) with undifferentiated carcinoma. The positive rate for SLX expression was significantly higher among patients with differentiated carcinoma than among those in undifferentiated carcinoma (P<0.0001). With differentiated carcinoma, the incidence of lymph node metastasis, advanced tumour stage (stage III and IV) and liver recurrence was significantly higher in SLX-positive patients than in SLX-negative ones (P<0.0001, P = 0.0065 and P = 0. 028, respectively). Moreover, the prognoses were better in patients with SLX-negative tumours than in those with SLX-positive tumours (P = 0.019). With undifferentiated carcinoma, there were no significant correlations between SLX expression and any clinicopathological features or prognoses. The clinicopathologic significance of SLX expression in gastric carcinoma patients depends on histologic type. SLX expression may be of great relevance in predicting liver metastases in patients with differentiated carcinoma.

Sites of expression of DnaJ homologs and Hsp70 in male and female flowers of the Japanese willow Salix gilgiana Seemen

We did in situ hybridization to identify the sites at which DnaJ homologs (SGJ1 and SGJ3) and Hsp70 were expressed in male and female flowers of the Japanese willow, Salix gilgiana Seemen. Transcripts of SGJ1, SGJ3, and Hsp70 were detected in microspores and in the tapetal layers of immature anthers, in the inner integument of ovules, and in the funicular epidermal layers of ovaries. Transcripts of SGJ3 and Hsp70 were also detected in the nectaries of male and female flowers, in which transcripts of SGJ1 were undetectable.

In vitro fertilization and intracytoplasmic sperm injection for couples with unexplained infertility after failed direct intraperitoneal insemination

PURPOSE

The objective was to determine the optimal insemination technique in patients undergoing in vitro fertilization (IVF) after failed direct intraperitoneal insemination (DIPI) and the outcome of intracytoplasmic sperm injection (ICSI) in such cases.

METHODS

In case-control studies, 53 couples with unexplained infertility who underwent IVF after four failed DIPI cycles were compared with 75 couples with tubal or endometriosis infertility as controls. Thirty couples with unexplained infertility after failing to conceive with DIPI and conventional IVF who underwent ICSI and 58 couples with male-factor infertility as controls also were compared. Fertilization cleavage, embryo quality, implantation, and pregnancy were compared after IVF and after ICSI.

RESULTS

There was a significant difference in fertilization rates after IVF between cases of unexplained infertility after failing to conceive with DIPI (40.4%) and patients with tubal or endometriosis infertility (67.9%). There also was a significant difference in total fertilization failure rates between the two groups (30.4% and 3.9%, respectively). There was a slight but significant difference in numbers of fertilized oocytes after ICSI between patients with low fertilization rate undergoing IVF after failing to conceive DIPI (85.8%) and patients with male factor (90.4%). Total fertilization failure was not observed in these cases.

CONCLUSIONS

Couples with unexplained infertility after failing to conceive with DIPI show a failed fertilization or a low fertilization rate after IVF. However, they demonstrated a good chance of becoming pregnant after subsequent ICSI, even with statistically significant difference in fertilization rate as compared with male-factor cases.

The staphylokinase gene is located in the structural gene encoding N-acetylmuramyl-L-alanine amidase in methicillin-resistant Staphylococcus aureus

The nucleotide sequence of a 15600-bp DNA fragment containing the staphylokinase gene (sakNU3-1) of methicillin-resistant Staphylococcus aureus (MRSA) NU3-1 was determined. The sak gene was found within the ply gene encoding N-acetylmuramyl-L-alanine amidase and thus the ply gene should be inactivated. In the flanking region of the sak gene, the tandem repeat sequences (GAAGTGTT and GAATGGTT) were present as possible junction points between the sak and ply genes. No sequences characteristic of the presence of an IS-like element were found. Upstream from the ply gene, the kdpA, kdpB and kdpC homologues were present. Downstream from the ply gene, the tagA, tagH and tagG homologues were present. The sak gene was inserted into the same position of ply in 5/6 of sak(+) MRSA isolates with different genotypes. In all of these sak(+) isolates, Sak was detected in the culture supernatant.

Effects of portal-systemic shunt following 90% partial hepatectomy in rats

We studied the effects of portal-systemic shunt after massive hepatectomy. Male Wistar rats were divided into two groups: one group underwent laparotomy alone (C group) and in the other group a portal-systemic shunt was placed through laparotomy (S group). After 90% hepatectomy was performed, 3-day and 1-week survival rates and histopathology were examined, and hepatic hemodynamics during the early stage after hepatectomy were measured using dye-containing microspheres. The 3-day survival rate in the S group was significantly higher, and the 1-week survival rate was slightly higher, than those in C group. Sinusoidal dilation 7 days after hepatectomy in the S group was significantly milder than that in the C group. Fatty degeneration of hepatocytes in the S group was significantly milder than that in the C group. With respect to hepatic hemodynamics during the early stage after hepatectomy, the rate of shunt (26.3%) in the S group was significantly higher than that (9.5%) in the C group. Portal pressure, total hepatic blood flow, and total hepatic blood flow per gram of liver in the S group were significantly lower than those in the C group. These results suggest that approximately 26% shunt after 90% hepatectomy in rats increases the early survival rate and improves histological changes in surviving rats 7 days after resection.

Male flower-specific expression of genes for polygalacturonase, pectin methylesterase and beta-1,3-glucanase in a dioecious willow (Salix gilgiana Seemen)

We isolated cDNA clones (pSgPG1 through pSgPG4, pSgPME1 and pSgGN1) for the polygalacturonases (PGs), pectin methylesterase (PME) and beta-1,3-glucanase (GN) that are expressed specifically in male flowers of the dioecious willow (Salix gilgiana Seemen). The structural characteristics of the deduced proteins, designated SgPGs, SgPME1 and SgGN1, respectively, suggest that these enzymes function in pollens or anthers. The four SgPGs were more than 91.9% homologous to one another at the amino acid level, indicating that their genes are members of a single family. Although the expression of the SgPGs, SgPME1 and SgGN1 was specific to male catkins (inflorescences), these genes were found in the genomes of both male and female plants. The expression of the transcripts of SgPGs, SgPME1 and SgGN1 was regulated developmentally in male reproductive organs. Maximal expression of SgPGs and SgPME1 was detected when male flowers were fully open and mature, while maximal expression of SgGN1 occurred at an earlier time. In situ hybridization revealed that the expression of SgPGs and SgPME1 was restricted to mature pollen grains after microspore mitosis. These results suggest that the pollen-specific or anther-specific expression of genes for PGs, PME and GN occurs in a dioecious plant, willow, just as it does in monoecious plants, and that the expression of these genes is related to the developmental stage of pollen grains during male gametogenesis.

Gasless laparoscopy under epidural anesthesia for adnexal cysts during pregnancy

OBJECTIVE

To evaluate laparoscopic adnexal cystectomy during pregnancy using an open technique with a whole abdominal wall-lift method under epidural anesthesia.

STUDY DESIGN

Seven cases of adnexal cysts during pregnancy were resected using a gasless laparoscopic (extracorporeal) method with a whole abdominal wall-lift. We performed this procedure without using general anesthesia or CO2 pneumoperitoneum.

RESULTS

All operations were performed successfully without complications. All patients resumed normal activity within one week. The subsequent antenatal courses of the patients were uneventful. There were no severe complications during the operations or postoperative courses. Six patients had vaginal deliveries of normal infants at term. No abnormal findings were found in the antenatal course of patient 7 until 30 weeks of gestation.

CONCLUSION

Based on our limited experience, this procedure may be safe.

Expression of DnaJ homologs and Hsp70 in the Japanese willow (Salix gilgiana Seemen)

We isolated three cDNA clones (pSGJ1, pSGJ2 and pSGJ3) for DnaJ-like proteins of the Japanese willow (Salix gilgiana Seemen). The insert in pSGJ2 included the entire nucleotide sequence of the insert in pSGJ1 that was separated into four parts by three intron-like sequences, and it might correspond to the cDNA for a precursor to the SGJ1 mRNA. The predicted amino acid sequences of SGJ1 (47.5 kDa) and SGJ3 (46.6 kDa) exhibited about 70 to 91% homology to plant cytoplasmic DnaJ-like proteins. SGJ1 was encoded by one or a few genes within the willow genome while SGJ3 was encoded by several genes. Expression of the SGJ1 and SGJ3 genes was compared with that of Hsp70 (SGK1) gene. Constitutive expression of SGJ1, SGJ3 and SGK1 was detected in all organs examined. The SGJ1 mRNA was most abundant in male catkins (inflorescences). High-level expression of SGJ3 and SGK1 was detected in catkins and roots of both male and female plants. The level of the SGJ3 mRNA in the leaves increased about 10-fold after 1 h of heat stress while the expression of SGJ1 mRNA reached a maximum level after 6 h. However, the extent of induction of SGJ1 mRNA was quite low. The levels of SGJ1 and SGJ3 mRNAs in the leaves increased about 6-fold and 2-fold, respectively, after 24 h of treatment with 100 mM NaCl. Thus, the SGJ1 and SGJ3 genes showed differential expression patterns in a variety of organs and in response to different environmental conditions.

GnRH agonist. Increasing the pregnancy rate after combined treatment with hMG/hCG and direct intraperitoneal insemination

OBJECTIVE

To evaluate the efficacy of the GnRH agonist (GnRHa) administered in conjunction with human menopausal gonadotropin/human chorionic gonadotropin hMG/hCG and direct intraperitoneal insemination (DIPI) in women with long-standing unexplained infertility.

STUDY DESIGN

A prospective, randomized, non-blind analysis. During the period May 1995-December 1996, couples with unexplained infertility who failed to conceive following superovulation combined with IUI for at least seven cycles were prospectively enrolled and followed. Pregnancy rates per cycle and per patient of DIPI were compared between groups of hMG/hCG with (GnRHa[+] controlled ovarian hyperstimulation [COH] group) or without (GnRHa[-] COH group) GnRHa.

RESULTS

Thirty-four women (59 cycles) underwent COH with hMG and GnRHa, and 31 women (49 cycles) received hyperstimulation with hMG alone. The pregnancy rates for the women administered GnRHa significantly exceeded those of the patients who did not receive GnRHa both per treatment cycle (35.6% versus 14.3%) and per couple (55.9% versus 22.5%).

CONCLUSION

The use of GnRHa with hMG/hCG and DIPI treatment significantly increased the pregnancy rate in women with long-standing infertility.

Transgenic mice harboring a full-length human mutant DRPLA gene exhibit age-dependent intergenerational and somatic instabilities of CAG repeats comparable with those in DRPLA patients

Dentatorubral-pallidoluysian atrophy (DRPLA) is one among an increasing number of hereditary neurodegenerative diseases determined as being caused by unstable expansion of CAG repeats coding for polyglutamine stretches. To investigate the molecular mechanisms underlying CAG repeat instability, we established three transgenic lines each harboring a single copy of a full-length human mutant DRPLA gene carrying a CAG repeat expansion. These transgenic mice exhibited an age-dependent increase (+0.31 per year) in male transmission and an age-dependent contraction (-1.21 per year) in female transmission. Similar tendencies in intergenerational instabilities were also observed in human DRPLA parent-offspring pairs. The intergenerational instabilities of the CAG repeats may be interpreted as being derived from the instability occurring during continuous cell division of spermatogonia in the male, and that occurring during the period of meiotic arrest in the female. The transgenic mice also exhibited an age-dependent increase in the degree of somatic mosaicism which occurred in a cell lineage-dependent manner, with the size range of CAG repeats being smaller in the cerebellum than in other tissues including the cerebrum, consistent with observations in autopsied tissues of DRPLA patients. Thus, the transgenic mice described in this study exhibited age-dependent intergenerational as well as somatic instabilities of expanded CAG repeats comparable with those observed in human DRPLA patients, and are therefore expected to serve as good models for investigating the molecular mechanisms of instabilities of CAG repeats.

CAG repeat expansions in patients with sporadic cerebellar ataxia

CAG repeat expansions cause spinocerebellar ataxia type 1 (SCA1), SCA2, SCA3, SCA6 and dentatorubral-pallidoluysian atrophy (DRPLA). So far these expansions have been examined mainly in ataxia patients with a family history. However, some sporadic cases with SCA have recently been reported. To elucidate the frequency and characteristics of sporadic SCAs, we screened 85 Japanese ataxia patients without a family history for the SCA1, SCA2, SCA3, SCA6 and DRPLA mutations. As a result, 19 patients (22%) were found to have expanded CAG repeats. Among sporadic SCAs, the SCA6 mutation was most frequently observed. The sporadic SCA6 patients had smaller CAG repeats and a later age of onset than SCA6 patients with an established family history. We also identified one father-child pair in which intermediate sized CAG repeats expanded into the SCA2 disease range during transmission. These findings suggest that patients with ataxia even without a family history should be examined for a CAG repeat expansion.

[Screaming during sleep in patients with Parkinson disease]

We studied 12 patients with Parkinson disease who scream while sleeping. All 12 patients showed clinical manifestations and brain images of typical idiopathic Parkinson disease. On average, the screaming began 4.8 years after the onset signs and symptoms of Parkinson disease. In many cases, sleep talking started before the onset of Parkinson disease. All patients reported that the screaming disrupted the sleep of their families, and half of the patients reported that the screams disturbed their own sleep. The screams were incorporated into their dreams. Clonazepam was effective to alleviate this screaming in 8 out of 9 cases. We considered this screaming to be caused by similar mechanisms as rapid eye movement (REM) sleep behavior disorder in which muscle atonia characterizing normal REM sleep is absent. The screams were not accompanied by other abnormal behaviors. We postulate that the screaming is a symptom closely related to that of mid or lower brainstem lesion in Parkinson disease because the neural activity of the locus ceruleus or the pudunculopontine nucleus are responsible for muscle atonia in REM sleep.

Possible direct effect of gonadotropin releasing hormone on human endometrium and decidua

Decidualization of endometrial tissues, which is essential for implantation and the continuation of pregnancy, is induced by pituitary hormones that are regulated by gonadotropin releasing hormone (GnRH). Our objective was to determine the role of a direct action of GnRH on endometrial tissues by comparing the characteristics of receptors for GnRH in human endometrial and decidual tissues. Competitive binding studies were performed with the protease-resistant GnRH analogues, buserelin and [125I] buserelin. The effects of buserelin on phosphoinositol turnover were determined by the measurement of inositol 1,4,5-triphosphate(IP3). The values for the dissociation constant (Kd) and number of binding sites (Bmax) per unit protein versus buserelin for endometrial tissues did not differ from the values for decidual tissues. However, the Bmax per unit DNA was significantly higher in endometrial tissues. Also, buserelin induced a significant increase in IP3 in decidual tissue. These results indicate that GnRH may be a potential modulator of the function in human endometrium and decidua. The signal transduction mechanism for GnRH action appeared to involve the accelerated turnover of phosphoinositol.

Spinocerebellar ataxia type 6. Molecular and clinical features of 35 Japanese patients including one homozygous for the CAG repeat expansion

Spinocerebellar ataxia type 6 (SCA6) is a newly classified autosomal-dominant cerebellar ataxia (ADCA) associated with CAG repeat expansion. We screened 111 patients with cerebellar ataxia for the SCA6 mutation. Of these, 35 patients were found to have expanded CAG repeats in the SCA6 gene, indicating that second to SCA3, SCA6 is the most common ADCA in Japan. Expanded alleles ranged from 21 to 29 repeats, whereas normal alleles had seven to 17 repeats. There was no change in the CAG repeat length during meiosis. The age at onset was inversely correlated with the repeat length. The main clinical feature of the 35 patients with SCA6 was slowly progressive cerebellar ataxia; multisystem involvement was not common. The 35 patients included nine cases without apparent family history of cerebellar ataxia. The sporadic cases had smaller CAG repeats (21 or 22 repeats) and a later age at onset (64.9 +/- 4.9 years) than the other cases with established family history. We also identified one patient who was homozygous for the SCA6 repeat expansion. The homozygote showed an earlier age of onset and more severe clinical manifestations than her sister, a heterozygote carrying an expanded allele with the same repeat length as the homozygote. This finding suggests that the dosage of the CAG repeat expansion plays an important role in phenotypic expression in SCA6.

[A case of esophageal leiomyoma found as mediastinal tumor, diagnosed with endoscopic ultrasonography]

A 20 year-old female was admitted to our department because of an abnormal shadow in chest roentgenogram on a physical check-up. The barium swallowing study revealed an oppression of the middle of the esophagus. Endoscopy, chest CT and MRI failed to distinguish submucosal tumor from mediastinal tumor. Endoscopic ultrasonography showed the mass originated from the esophagus and a diagnosis of esophageal smooth muscle tumor was obtained. The tumor was tried to resect by thoracoscopic surgery but was failed because of its shape like a tortoise shell. The tumor was resected through the right thoracotomy and the diagnosis was confirmed histopathologically.

[An apparently sporadic case with spinocerebellar ataxia type 1 (SCA1)]

We reported a sporadic case with late onset SCA1. There was no family history of neurological diseases. His parents had been healthy until they died at the age of 77 and 89 years, respectively. The patient noticed gait disturbance at age of 60. Thereafter, he gradually developed cerebellar ataxia, hyporeflexia, mild atrophy of the facial and limb muscles and moderate deep sensory disturbance. MRI of the brain showed moderate atrophy of the cerebellum and brainstem. Sequencing analysis of SCA1 gene demonstrated that the patient had an expanded allele with 40 CAG repeats and no CAT interruption. Consequently, he was diagnosed as having SCA1. These results suggest the possibility that among apparently sporadic cases with cerebellar ataxia, there are some cases of SCA1 with mild CAG repeat expansion.

Malignant lymphoma in patients with rheumatic diseases other than Sjögren's syndrome: a clinicopathologic study of five cases and a review of the Japanese literature

We conducted clinicopathologic and immunohistochemical analysis of five patients with malignant lymphoma complicating rheumatic diseases other than Sjögren's syndrome, and reviewed 26 cases of similar lesions reported in the Japanese literature over a 17-year period. All five patients were women ranging in age from 31 to 74 years (mean 55 years). Two of them fulfilled the diagnostic criteria for systemic lupus erythematosus, two for dermatomyositis and one for progressive systemic sclerosis. The use of immunosuppressive drugs before the onset of malignant lymphoma was recorded in four patients. All the biopsied or resected specimens showed non-Hodgkin's lymphoma of B-cell phenotype. Three were nodal in origin (one diffuse mixed, one diffuse large cell and one immunoblastic) and two were extranodal (one low-grade B-cell lymphoma of mucosa-associated lymphoid tissue and one diffuse large cell). In three of four cases examined, Epstein-Barr virus-encoded small RNAs were identified in a small to large number of the lymphoma cells by in situ hybridization. Our study showed that the clinicopathological features of malignant lymphomas complicating rheumatic disease in Japan were similar to those in England and the USA. Furthermore, our findings suggested no evidence for a causative association between iatrogenic immunosuppression due to methotrexate therapy and the development of EBV-related lymphoid neoplasms.

Relationship of (CAG)nC configuration to repeat instability of the Machado-Joseph disease gene

The mutation responsible for Machado-Joseph disease (MJD) has been identified as an expansion of a CAG trinucleotide repeat in a novel gene on chromosome 14q32.1. The CAG repeat tract is followed by C or G, and alleles are thereby divided into two types on the basis of molecular configuration, (CAG)nC and (CAG)nG. We have studied the relationship between the repeat length and the configuration in 38 patients from 28 Japanese families with MJD, and 31 unrelated normal Japanese subjects. The CAG repeat length in 100 normal alleles ranged from 13 to 37 repeats, while 38 MJD patients had one expanded allele with 64 to 84 repeats. Surprisingly, the expanded alleles had exclusively the (CAG)nC configuration, while both (CAG)nC and (CAG)nG were seen in normal alleles from MJD and control subjects. Furthermore, in normal alleles, the CAG repeat tract was significantly longer in (CAG)nC than in (CAG)nG. These findings suggest that the (CAG)nC configuration is related to repeat instability of the MJD gene.

Autosomal dominant cerebellar ataxias in the Kinki area of Japan

The autosomal dominant cerebellar ataxias are a heterogeneous group of neurodegenerative disorders characterized by slowly progressive cerebellar ataxia. Recently, among the ataxias, spinocerebellar ataxia type 1 (SCA1), Machado-Joseph disease (MJD) and dentatorubral-pallidoluysian atrophy have been found to be caused by expansion of a CAG trinucleotide repeat in the coding region of the disease genes. We have analyzed the CAG repeats of 67 patients from 47 families with dominantly inherited ataxia who lived in the Kinki area of Japan. The following results were obtained. First, 31 patients from 22 families were found to be positive for the MJD repeat expansion, indicating that MJD is the most common dominantly inherited ataxia in the Kinki area of Japan. Second, no SCA1 repeat expansion was found among the families studied. This presents a striking contrast to the fact that there are many families with SCA1 in Hokkaido and the Tohoku area of Japan. These findings suggest geographic variation in autosomal dominant cerebellar ataxias in Japan.

[Association of Epstein-Barr virus with primary malignant lymphomas of the digestive tract]

The association of Epstein-Barr virus (EBV) with 85 non-Hodgkin lymphomas of the digestive tract in nonimmunocompromised cases was investigated, using in situ hybridization technique to detect EBV encoded small RNAs in paraffin sections. 85 cases (83 B-cell type and 2 T-cell type) included 3 gingivas, 1 tongue, 3 palates, 10 tonsils, 43 stomachs, 2 jejunums, 12 ileums, 3 ileo-cecal regions, 5 colons and 3 rectums. Out of 85 cases, 4 (4.7%) were EBV-positive, comprising 1 B-cell lymphoma of the tonsil, 2 B-cell lymphomas of the stomach, and 1 T-cell lymphoma of the rectum. On the other hand, EBV-positive rate in nasal/nasopharyngeal lymphomas examined for comparison was very high, 81.8% (9 out of 11). These results show that EBV is associated with only a small proportion of lymphomas of the digestive tract in nonimmunocompromised case, suggesting the existence of the other oncogenetic factors in the pathogenesis of this group of lymphomas.

[A sporadic case of dentatorubral-pallidoluysian atrophy (DRPLA) having an elderly age of onset]

We reported a sporadic case of DRPLA that had an elderly age of onset. The patient was a 71-year-old woman. Her parents, sisters and a brother didn't have neurologic diseases. She had been well until the age of 68 years, when she noticed her unstable gait. On neurologic examination cerebellar ataxia and a tremor at the neck were noticed, but we were unable to differentiate her disease from the other types of spinocerebellar degeneration. An MRI of the cranium showed atrophy of the cerebellum, pons, brain stem and cerebrum, and a diffuse lesion of the cerebral white matter. These findings made us suspect her disease of DRPLA. When we analyzed the CAG repeat in the DRPLA gene, we found it expanded to 57. We thought that the elderly onset related to a relatively mild expansion.

Clinicopathologic study of primary gastric lymphoma of B cell phenotype with special reference to low-grade B cell lymphoma of mucosa-associated lymphoid tissue among the Japanese

Resection specimens from 83 patients with primary gastric lymphoma (PGL) of B cell phenotype at stage IE and at stage IIE according to the Ann Arbor classification were investigated. Histologically, these lymphomas could be divided into four types: Type I lesions (n = 24) were entirely made up of MALT lymphoma; Type II lesions (n = 13) were predominantly MALT lymphoma containing one to a few foci of high-grade B cell lymphoma; Type III lesions (n = 22) consisted largely of high-grade lymphoma with small areas of low-grade MALT lymphoma; and Type IV lesions (n = 24) were pure high-grade B cell lymphoma, mostly of the large cell type. All patients had undergone primary gastric resection, and 14 received additional chemotherapy (n = 12), or both chemotherapy and radiotherapy (n = 2). The survival probability was significantly higher for Types I and II lymphomas than for Types III and IV tumors (P < 0.05 by the generalized Wilcoxon test). According to The General Rules for the Gastric Cancer Study by the Japanese Research Society for Gastric Cancer, the stage of disease showed a clear distinction between each of them (P < 0.01 by the generalized Wilcoxon test). This staging method seemed to serve well as a prognostic indicator. The histological typing of the PGL of the present series also seemed to correlate with the gross appearance, pathologic stage and prognosis. Furthermore, the expression of cyclin D1, bcl-2 and p53 protein, and PCNA was immunohistochemically investigated in 42 cases of the present series. Most of the low-grade PGL (Types I and II) had less than 60% PCNA-positive cells, whereas the high-grade PGL (Types III and IV) had more than 60% positive cells. In a study for cyclin D1 protein, no cases showed the nuclear staining pattern characteristic for mantle cell lymphoma, and the cytoplasmic staining frequently observed in the node-based large B cell lymphoma was seldom identified in the PGL. This discrepancy might suggest a lineage difference among the morphologically similar, but site-different, lymphomas. On the other hand, bcl-2 protein overexpression was almost equal in frequency between the gastric and node-based high-grade B cell lymphomas. This is in contrast to the reports from Western countries, in which the majority of high-grade gastric tumors were bcl-2 negative.

A structural polymorphism of human dopamine D2 receptor, D2(Ser311-->Cys)

No structural change of the dopamine D2 receptor (DRD2) has been reported so far, though the DRD2 gene has been suggested to be one of the candidate genes for mental disorders. Herein we report one missense nucleotide mutation from C to G resulting in a substitution of serine with cystein at the codon 311 located in the third intracellular loop of the DRD2 that was found in the analyses of the sequence of the DRD2 gene in 50 schizophrenics. The allele frequency, 0.04, of this Cys311 allele in 50 schizophrenics was slightly increased compared with that, 0.023, in 110 controls though the difference was not significant. The schizophrenics with Cys311 tended to have a lower age of onset and a positive family history of schizophrenia.

[A case of the thyroidea ima artery arising from the aortic arch]

The present report describes a case of the thyroidea ima artery observed in a 65-year-old Japanese male on dissection in 1988. The thyroidea ima artery arose from the aortic arch between the branchiocephalic trunk and the left common carotid artery. The thyroidea ima passed to the left lobe and isthmus of the thyroid gland for the supply of these. The inferior thyroid artery on the right side was of common type in its origin and course, though that on the left side was absent. Either of the superior thyroid arteries arose from the common carotid artery.