Evaluation of Intracerebral Grafting of Dopamine-Secreting PC12 Cells into Allogeneic and Xenogeneic Brain

The PC12 pheochromocytoma tumor cell line is derived from a rat adrenal medullary tumor and secretes dopamine. We have previously reported that grafted microencapsulated PC12 cells using agarose and poly(styrene sulfonic acid) survived in the xenogeneic brain without immunosuppression. To investigate whether unencapsulated PC12 cells form a tumor and how they provoke immunological reaction, PC12 cell suspension was implanted into the striatum of Sprague-Dawley rat (allogeneic graft) or guinea pig (xenogeneic graft) and histological analysis using Nissl stain and immunocytochemical analysis using antityrosine hydroxylase (TH) antibody were performed 1, 2, and 4 wk after transplantation. Host animals were not immunosuppressed. PC12 cells formed a mass 1 and 2 wk after transplantation both in allogeneic and xenogeneic brain. These grafted PC12 cells were immunoreactive to anti-TH antibody. Four weeks after transplantation, however, grafted PC12 cells in the allogeneic brain were only found within the restricted area near the site of implantation. In the xenogeneic brain, only the trace of grafted PC12 cells were found around the site of implantation 4 wk after transplantation. In both allogeneic and xenogeneic animals, a number of lymphocytes were found in and around the grafts at all period investigated. These findings indicate that PC12 cells could survive in the allogeneic or xenogeneic brain for 2 wk and were ultimately rejected by immunological reaction by 4 wk after transplantation. Implantation of encapsulated PC12 cells in the allogeneic or xenogeneic brain is considered a safe and effective method for delivering dopamine into the brain because PC12 cells will not form a tumor in the long-term even if capsules are damaged in some reason.

Evaluation of glucose metabolism after distal pancreatectomy according to the donor criteria of the living donor pancreas transplantation guidelines proposed by the Japanese Pancreas and Islet Transplantation Association

BACKGROUND

Living donor pancreas transplantation (LDPT) reduces the number of deaths of diabetic patients on dialysis and of candidates on the waiting lists and helps to overcome the organ shortage. Stringent criteria must be applied to minimize the risk of metabolic complications for living donors. The Japanese Pancreas and Islet Transplantation Association (JPITA) proposed LDPT guidelines in 2010. In this study, we retrospectively evaluated glucose metabolism of the patients who underwent distal pancreatectomy (DP) according to the donor criteria of the LDPT guidelines proposed by the JPITA.

METHODS

Fifty-two nondiabetic patients who underwent DP were divided into 2 groups according to the donor criteria: indication group (IG, n = 14) who had age ≤ 65, hemoglobin A1c (HbA1c) < 5.9%, and body mass index (BMI) < 25 kg/m(2). The other patients were placed in the no indication group (NG, n = 38). Clinical data and percent resected volume (PRV) of each pancreas as determined by multi-detector row computed tomography volumetry were compared between the 2 groups.

RESULTS

During the follow-up period (median 12 months), 14 patients (27%) developed new-onset diabetes within a median onset time of 10 months (range 3-24 months) postoperatively. No patient in the IG developed new-onset diabetes. On the other hand, 37% of the patients in the NG developed new-onset diabetes. There were significant between-group differences in changes in preoperative serum fasting glucose and HbA1c levels, whereas there were no significant between-group differences in preoperative serum albumin or body weight. Multivariate analysis identified preoperative HbA1c (odds ratio 51.6, P = .002) and PRV (odds ratio 2.07, P = .033) as independent risk factors for new-onset diabetes.

CONCLUSION

Living donor criteria in the LDPT guidelines proposed by the JPITA are appropriate for prevention of glucose metabolic complications in donors. Further long-term follow-up studies of living donors' metabolic function are needed to clarify the safety of the donor.

Functioning pancreas graft with thromboses of splenic and superior mesenteric arteries after simultaneous pancreas-kidney transplantation: a case report

Graft thrombosis is the most common cause of early graft loss after pancreas transplantation. The grafted pancreas is difficult to salvage after complete thrombosis, especially arterial thrombosis, and graft pancreatectomy is required. We describe a patient presenting with a functioning pancreas graft with thromboses of the splenic artery (SA) and superior mesenteric artery (SMA) after simultaneous pancreas-kidney transplantation (SPK). A 37-year-old woman with a 20-year history of type 1 diabetes mellitus underwent SPK. The pancreaticoduodenal graft was implanted in the right iliac fossa with enteric drainage. A Carrel patch was anastomosed to the recipient's right common iliac artery, and the graft gastroduodenal artery was anastomosed to the common hepatic artery using an arterial I-graft. The donor portal vein was anastomosed to the recipient's inferior vena cava. Four days after surgery, graft thromboses were detected by Doppler ultrasound without increases in the serum amylase and blood glucose levels. Contrast enhanced computed tomography revealed thromboses in the SA, splenic vein and SMA. Selective angiography showed that blood flow was interrupted in the SA and SMA. However, pancreatic graft perfusion was maintained by the I-graft in the head of the pancreas and the transverse pancreatic artery in the body and tail of the pancreas. We performed percutaneous direct thrombolysis and adjuvant thrombolytic therapy. However, we had to stop the thrombolytic therapy because of gastrointestinal hemorrhage. Thereafter, the postoperative course was uneventful and the pancreas graft was functioning with a fasting blood glucose level of 75 mg/dL, HbA1c of 5.1%, and serum C-peptide level of 1.9 ng/mL at 30 months post-transplantation.

Tips for preventing cerebrospinal fluid rhinorrhea after acoustic neurinoma surgery: technical note

CSF rhinorrhea is a common complication of acoustic neurinoma surgery via the suboccipital route. In this paper we present our incidence of CSF rhinorrhea and our surgical techniques for reducing the risk of this post-surgical complication. Following removal of the acoustic neurinoma, the drilled posterior wall of the internal auditory canal is covered with bonewax, muscle or fat pieces, and fibrin-glue, while the previously reflected dura is sutured in place keeping the packing material in position. Bone chips removed during the craniectomy are then mixed with fibric glue and are used for a cranioplasty. Although we routinely perform aggressive drilling of internal auditory canal to facilitate total removal of the acoustic neurinoma, only 1 out of 94 consecutive cases (1%) showed postoperative CSF rhinorrhea. Since previous reports mention the rate of this complication following acoustic neurinoma surgery varies between 4% and 27%, we believe that our methods may be useful in helping reduce the incidence of postoperative rhinorrhea.

Mesenchymal stem cells facilitate the induction of mixed hematopoietic chimerism and islet allograft tolerance without GVHD in the rat

Induction of hematopoietic chimerism and subsequent donor-specific immune tolerance via bone marrow transplantation is an ideal approach for islet transplantation to treat type-1 diabetes. We examined the potential of mesenchymal stem cells (MSCs) in the induction of chimerism and islet allograft tolerance without the incidence of graft-versus-host disease (GVHD). Streptozotocin-diabetic rats received a conditioning regimen consisting of antilymphocyte serum and 5 Gy total body irradiation, followed by an intraportal co-infusion of allogeneic MSCs, bone marrow cells (BMCs) and islets. Although all the recipients rejected the islets initially, half of them developed stable mixed chimerism and donor-specific immune tolerance, shown by the engraftment of donor skin and second-set islet transplants and acute rejection of a third-party skin. The engraftment of the primary islet allografts with stable chimerism was achieved by the addition of a 2-week peritransplant administration of 15-deoxyspergualin (DSG). Without MSCs, none of the recipients treated with DSG developed chimerism or reversal of diabetes. GVHD was not observed in any of the recipients infused with MSCs (0/15), whereas it occurred in 4/11 recipients without MSCs. These results indicate a potential use of MSCs for induction of hematopoietic chimerism and subsequent immune tolerance in clinical islet transplantation.

In vitro combined effects of cefozopran/teicoplanin and cefozopran/vancomycin on methicillin-resistant Staphylococcus aureus

We determined the in vitro effects of teicoplanin (TEIC) or vancomycin (VCM) added to cefozopran (CZOP) on 50 methicillin-resistant Staphylococcus aureus (MRSA) strains, using a modified checkerboard method with serial 1.25-fold dilutions, and assessed the time-kill curve. CZOP + TEIC was synergistic (fractional inhibitory concentration index < or = 0.5) against 98% and CZOP + VCM against 20% of strains. Both drug combinations were additive against the remaining strains. A comparison of the fractional bactericidal concentration indices for 32 strains showed synergistic bactericidal effects for CZOP + TEIC in 88%, and in 48% for CZOP +VCM, confirming that CZOP + TEIC is superior to CZOP + VCM. The time-kill curve confirms that the bactericidal potency of these drugs is increased through combined use with CZOP. These results suggest that treatment using TEIC or VCM with CZOP may be useful in treating MRSA infections, including polymicrobial infections and those involving Gram-negative rods.

Utility of Etest in choosing appropriate agents to treat fungal keratitis

PURPOSE

To evaluate the utility of Etest in choosing the appropriate treatment of fungal keratitis.

METHODS

Etest was used to determine the drug sensitivities of isolates from the eyes of three patients with fungal keratitis, and the clinical outcomes of treatment with selected drugs were evaluated.

RESULTS

In all cases, drug sensitivity demonstrated by Etest accorded with clinical efficacy of the drugs.

CONCLUSION

The results in these cases suggest that evaluating drug sensitivities with Etest is an efficient means of selecting optimal pharmacotherapy for fungal keratitis.

[Strip immunoblot assay (SIA) with recombinant antigens and synthetic peptide for detection of anti HIV-1 and HIV-2 antibodies]

The serodiagnosis of human immunodeficiency virus (HIV) infection has widely been established by the screening test and the confirmatory test. At present, Western blot (WB) assay is mostly used as the confirmatory test. However, this method has the problem in that the sensitivity and the specificity are not enough. A new confirmatory test "CHIRON RIBA HIV-1/HIV-2 SIA" developed by Chiron Corporation uses an immunoblot enzyme immunoassay technique for detection of anti HIV-1 and/or HIV-2 antibodies. This assay employs four recombinant viral antigens (gp120, gp41, p24/p26 and p31) and a synthetic viral antigen (HIV-2 envelope peptide). The characteristic of this method is that the HIV-1 infection and the HIV-2 infection can be differentiated from each other. We therefore compared this SIA method with the WB1 assay for detection of anti HIV-1 antibodies and with the WB2 assay for detection of anti HIV-2 antibodies. Eighty samples from normal adults without HIV infection and known to be negative by three HIV screening tests, respectively, were tested by SIA, WB1 and WB2 assays. The negative rates (specificities) were 97.5%, 80.0% and 87.5% by the SIA, WB1 assay and WB2 assay, respectively. With forty samples from patients without HIV infection but known to be positive by at least one HIV screening test, the negative rates (specificities) were 97.5%, 72.5% and 85.5% by the SIA, WB1 assay and WB2 assay, respectively. The results indicated that the SIA method was more specific than two WB assays. Forty samples from patients with HIV-1 infection and known to be positive by three HIV screening tests, were tested by the SIA and WB1 assay. The positive rates (sensitivities) were 97.5% and 75.0% by the SIA and WB1 assay, respectively. With thirteen samples from patients with HIV-2 infection and known to be positive by three HIV screening test, the positive rates (sensitivities) were 100% and 92.3% by the SIA and WB1 assay, respectively. The results indicated that the SIA method was more sensitive than the WB1 assay. Three sets of sera, which were collected during seroconversion for HIV-1 antibody, were used to compare the positive readings by the SIA and WB1 assay. The SIA method indicated the positive readings earlier than the WB1 assay. The present findings indicated that the SIA method was more specific and sensitive than the WB assay, and would be useful as a confirmatory test.

Effects of aging on cerebral vasospasm after subarachnoid hemorrhage in rabbits

BACKGROUND AND PURPOSE

The effects of aging on cerebral vasospasm after subarachnoid hemorrhage (SAH) remain to be elucidated. The aim of this study was to clarify age-related differences of vasospasm and of papaverine reactivity in the responses of basilar arteries after SAH in rabbits.

METHODS

Rabbits receiving a single injection of arterial blood into the cisterna magna were divided into 3 groups: young (2 to 3 months old), adult (6 to 9 months old), and old (20 to 40 months old). Vertebrobasilar angiograms were obtained before SAH and 1, 2, 4, and 7 days after SAH. Papaverine was administrated selectively via the vertebral artery on day 2, and serial angiography was performed for up to 2 hours. Vessel structures were assessed with light microscopy on days 1, 2, 4, and 7 after SAH and at 10, 30, and 60 minutes after papaverine infusion.

RESULTS

Mortality from SAH in old rabbits was 40%, whereas that of young and adult rabbits was 0%. Angiograms revealed that SAH induced maximal constriction of the basilar arteries on day 2 in all age groups, and the constrictions were significantly increased with age at all time points investigated. The degree of dilatation of spastic basilar arteries after intra-arterial papaverine administration significantly decreased with age. Duration of the efficacy of papaverine became significantly shorter with age. Vessel diameter returned to the preinfusion value approximately 120, 60, and 30 minutes after infusion in young, adult, and old rabbits, respectively. Light microscopy in old rabbits showed luminal narrowing and corrugation of the internal elastic lamina not only in the basilar arteries but also in small arteries and intraparenchymal arterioles.

CONCLUSIONS

This study suggests that aging increases the degree of vasospasm in rabbits. The impaired reactivity to papaverine with aging might imply the early transition of the aged vessel to the papaverine-resistant chronic stage.

[Informed consent for the use of the remaining portion of laboratory specimens for education, research, and quality control of laboratory tests]

The remaining portion of a laboratory specimen is usually used for education, research, and quality control of laboratory tests in hospitals, but informed consent has not been obtained because of the high volume of patients who undergo laboratory tests. However, patients must be informed in some manner. Therefore, we decided to inform patients that any remaining specimen would be used for various purposes by placing such a notice on walls in the central clinical laboratory and hospital lobby. We then obtained a signature on a dissent document, instead of a consent document, from any patient who dissented from such use. This indirect process for obtaining informed consent was approved by the ethics committee of Osaka University Medical School. The number of dissent documents sent in to the director was 54 of about 400,000 patients who underwent laboratory tests over the last 3 years, and there was no complaint against this "informed consent process".

Inhibition of poly(ADP-ribose) polymerase attenuates cerebral vasospasm after subarachnoid hemorrhage in rabbits

BACKGROUND AND PURPOSE

Poly(ADP-ribose) polymerase (PARP) is important in modulating inflammation, which has been implicated in cerebral vasospasm after subarachnoid hemorrhage (SAH). We investigated the role of PARP in vasospasm using 3-aminobenzamide (3-AB), a PARP inhibitor, in a rabbit model.

METHODS

Twenty-four New Zealand White rabbits were divided into 4 groups: (1) no treatment (control group, n=6); (2) blood injection without pretreatment (SAH-only group, n=6); (3) blood injection with pretreatment by vehicle (SAH+vehicle group, n=6); and (4) blood injection with pretreatment by 3-AB (SAH+3-AB group, n=6). We used the single-hemorrhage model of SAH, injecting autologous arterial blood into the cisterna magna. Angiography was performed before (baseline) and after (day 2) SAH, and the diameter of the basilar artery (BA) was measured. Animals were euthanatized after the second angiogram. After perfusion and fixation, the brains were cut into sections for hematoxylin and eosin and immunohistochemical staining for poly(ADP-ribosyl)ation.

RESULTS

In the control group, there were no differences in the BA lumen caliber between baseline and day 2 (96.8+/-10.4%). Cerebral vasospasm in the SAH+3-AB group (88.2+/-6. 2%) was remarkably attenuated in comparison with that in the SAH-only group (64.9+/-8.0%) and the SAH+vehicle group (65.6+/-10. 8%). The BA in the SAH+3-AB group showed less corrugation of the tunica elastica interna than that in the SAH-only and SAH+vehicle groups. Staining for poly(ADP-ribosyl)ation was markedly inhibited in smooth muscle and adventitial cells of the BA in the SAH+3-AB group compared with other groups.

CONCLUSIONS

Inhibiting ADP-ribosylation attenuates cerebral vasospasm after SAH in rabbits, and PARP activation may play an important role in the development of cerebral vasospasm.

Cerebral gangliogliomas: clinical characteristics, CT and MRI

Eight patients with ganglioglioma who received surgical treatment at our institute between January 1989 and January 1997 were reviewed to determine their clinical, CT and MRI characteristics. Tumours were located in the temporal lobe (four patients), trigone of the lateral ventricle (two patients), basal ganglia (one patient) and fronto-temporal lobe (one patient). On imaging, two types of tumours were seen, a solid mass in 5 patients (62.5%) and a cystic mass in three patients (37.5%). Six complete tumours (75%) and all of the solid components of the cystic tumours were enhanced by contrast medium. Seven tumours (88%) had no peripheral oedema. On CT, the tumours being studied appeared as iso-(62.5%) or low density (37.5%) intra-axial tumours. Four tumours (50%) contained calcification. On MRI, the tumours appeared as well-circumscribed, iso-(62.5%) or low intensity (37.5%) intra-axial tumours on T1 weighted images, and as high (75%) on T2 weighted images. Three underwent total resection, 2 subtotal resection and 3 partial resection. No patients had have any further treatment such as radiation therapy or chemotherapy. Postoperative studies were conducted on all patients with an average follow-up period 56 months (range 4-147 months) after surgery. There was no evidence of recurrence of tumours or of growth of residual tumours. We observed gangliogliomas which were located in unusual regions such as the trigone in two of the patients. To our knowledge, our series is the first report to describe trigonal gangliogliomas. We conclude, therefore, that ganglioglioma should be included as a possibility in the differential diagnosis of intracranial masses, even when they are located in the trigone.

Bacterial toxins and detection methods

The diagnosis of infectious disease has been carried out by detecting causative organisms from patient's clinical materials using culture methods so far. However, the method for rapid analysis and diagnosis has been changed by development of advanced methods such as immunological, molecular biological and genetic method. Especially, as a mass outbreak of entrohaemorrhagic E. coli (O157), which is reguired to detect toxins as well as bacteria itself, microbiologists and clinicians recognized the significance of rapid analysis of bacterial toxins. On the diagnosis for the state of disease and decision for the way of the therapy, the rapid detection of bacterial toxin is a significant indispensable tests. From these point of view, introduction of rapid analysis into a laboratory, not using cell culture or experimental animals, is strongly required. Here I describe a various kind of bacterial toxins and their detection methods.

Suitable image parameters and analytical method for quantitatively measuring cerebral blood flow volume with phase-contrast magnetic resonance imaging

The aim of this study was to determine suitable image parameters and an analytical method for phase-contrast magnetic resonance imaging (PC-MRI) as a means of measuring cerebral blood flow volume. This was done by constructing an experimental model and applying the results to a clinical application. The experimental model was constructed from the aorta of a bull and circulating isotonic saline. The image parameters of PC-MRI (repetition time, flip angle, matrix, velocity rate encoding, and the use of square pixels) were studied with percent flow volume (the ratio of actual flow volume to measured flow volume). The most suitable image parameters for accurate blood flow measurement were as follows: repetition time, 50 msec; flip angle, 20 degrees; and a 512 x 256 matrix without square pixels. Furthermore, velocity rate encoding should be set ranging from the maximum flow velocity in the vessel to five times this value. The correction in measuring blood flow was done with the intensity of the region of interest established in the background. With these parameters for PC-MRI, percent flow volume was greater than 90%. Using the image parameters for PC-MRI and the analytical method described above, we evaluated cerebral blood flow volume in 12 patients with occlusive disease of the major cervical arteries. The results were compared with conventional xenon computed tomography. The values found with both methods showed good correlation. Thus, we concluded that PC-MRI was a noninvasive method for evaluating cerebral blood flow in patients with occlusive disease of the major cervical arteries.

Cerebral aneurysms causing visual symptoms: their features and surgical outcome

Cerebral aneurysms causing visual symptoms before surgery are relatively rare. We have experience with 17 cases of such aneurysms and report their clinical features and surgical outcome. The locations of aneurysms presenting with visual dysfunction in our series are as follows: internal carotid (IC)-cavernous aneurysms in six of 29 total cases, 21%; IC-ophthalmic aneurysms in nine of 36 total cases, 25%; and anterior communicating artery (A com A) aneurysms in two of 217 total cases, 1%. The size of the aneurysms, the period between the onset of symptoms and surgical treatment, the pre- and post-operative visual function, and the surgical methods used to treat the aneurysm were analyzed. All the visually symptomatic cases featured large (15-24 mm) or giant (> 25 mm) aneurysms. Visual symptoms occurred before aneurysmal rupture in all cases but one. The type of visual field defect and the degree of reduced visual acuity were highly variable, without a typical clinical presentation. Five out of six IC-cavernous aneurysms were treated surgically with common carotid artery (CC) ligation or IC ligation with superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis. Three of these cases showed improvement of visual symptoms after surgery. Six out of nine IC-ophthalmic aneurysms were treated surgically (CC ligation or direct clipping), with four cases showing improvement of visual symptoms after surgery. One case of an A com A aneurysm featured a ruptured aneurysm that had physically penetrated the optic chiasm, while the other case was a giant unruptured aneurysm. The interval between the onset of symptoms and surgical treatment was the only factor identified which affected the clinical outcome of the aneurysms presenting with visual dysfunction. All cases that were determined to show improvement of visual function were treated surgically within 3 months of the onset of symptoms. Cerebral aneurysms presenting with visual dysfunction before surgery are most commonly large or giant, and unruptured. Recovery of visual function can most often be expected when surgical treatment is performed expeditiously, before the visual dysfunction becomes irreversible.

Effects of lecithinized SOD on sequential change in SOD activity after cerebral contusion in rats

To analyze the effect of lecithinized superoxide dismutase (SOD) on superoxide accumulation after traumatic brain injury (TBI) in rats, we studied the SOD activity by NBT-reducing method and the expression of Cu,Zn-SOD mRNA by Northern blot analysis. As determined by the specific gravity method, the administration of lecithinized SOD decreased brain edema in the periphery of the lesion at 6 hr after contusion. SOD activity, without lecithinized SOD administration, increased at the peripheral portion at 30 min after contusion, but decreased to normal level at 6 hr after TBI. By administration of lecithinized SOD, the increase of SOD activity was preserved until 6 hr after TBI. The expression of Cu,Zn-SOD mRNA increased in the core lesion, peripheral portion, and contralateral hemisphere until 6 hr after TBI, then was suppressed in all three areas by lecithinized SOD. These results support the hypothesis that superoxide anions may play an important role in the development of brain edema after TBI, and that leciyhinized SOD appears to prevent brain edema through a protective effect against superoxide anions.

Acanthamoeba keratitis with symbiosis of Hartmannella ameba

PURPOSE

To report a case of severe amebic keratitis in which both Hartmannella and Acanthamoeba were isolated simultaneously from the same lesion.

METHOD

Case report. The deep corneal lesion was scraped for cytopathology and isolation of the pathogens. We tested the in vitro sensitivities of the pathogens to several drugs.

RESULTS

Cultures of the corneal scrapings and of the solution in the patient's contact lens storage case were positive for Acanthamoeba E9 cysts and trophozoites. Hartmannella ameba coexisted with Acanthamoeba in the cornea. When tested in vitro, Acanthamoeba trophozoites were sensitive to both miconazole nitrate and natamycin, while cysts were sensitive only to natamycin. However, the patient did not respond to these antiamebic drugs.

CONCLUSIONS

This case suggests that Acanthamoeba is not the only origin of amebic keratitis. Hartmannella may also cause severe drug-resistant keratitis.

Decoy administration of NF-kappaB into the subarachnoid space for cerebral angiopathy

Subarachnoid hemorrhage (SAH), encephalitis, meningitis, and autoimmune diseases sometimes lead to cerebral angiopathy, characterized specifically by narrowing of vessels, morphological changes in the structure of vessel walls, and a concomitant decrease in cerebral blood flow. Many patients also develop delayed ischemic neurological deficits. Thus, preventing vascular reactions is of paramount importance in treating SAH. Although cerebral vasospasm has some relationship with the inflammatory reaction of major cerebral vessels against the autologous blood, and many trials have attempted to prevent angiopathy after SAH, an effective treatment has not yet been established. The purpose of this article is to evaluate the preventive effect of nuclear factor KB (NF-kappaB) decoy oligo-DNA after SAH; since NF-kappaB is closely related to inflammation. In the rabbit angiopathy model after SAH, we evaluated the effectiveness of the decoy oligo-DNA using the angiographic (digital subtraction angiography) and histological (hematoxylin-eosin and Masson's trichrome staining) methods. Moreover, a gel-shift assay for NF-kappaB was also performed in order to evaluate the activity of NF-kappaB. We describe a new concept for treating cerebral angiopathy after SAH and for successfully inhibiting cerebral vasospasm and morphological changes in vessel walls in a rabbit model. In this treatment, we used synthetic double-strand oligo-DNA with a high affinity for transcription factor NF-kappaB, and cationic liposome complex administered through the cerebrospinal fluid.

Detection of lipid peroxidation and hydroxyl radicals in brain contusion of rats

To examine the relationship between the free radicals and brain tissue damage, we investigated the intensity of brain hydroxyl (OH) radical generation and lipid peroxidation in the rat contusion injury model. A unilateral contusion was induced by a weight-drop method. All rats were decapitated six hours after the injury, and brain samples were taken from three portions (core, peripheral, and distal) to examine the specific gravity as an indicator of brain edema, generation of OH using an electron paramagnetic resonance spectrometer (EPR), and malondialdehyde (MDA) and 4-hydroxyalkenals production. Analysis of the specific gravity revealed cerebral edema on the ipsilateral side in the injured group. The signal intensity of EPR in the core and peripheral portions in the contusion group was significantly higher than that in the distal portion of the contusion group and that of all portions in the control animals. No significant difference was observed between the core and peripheral portions of the contusion group. The MDA and 4-hydroxyalkenals production was significantly higher in the core and peripheral portions than in the distal portion of the contusion group and that of all portions of the control group. The degree of posttraumatic brain edema was closely correlated with the increase of DMPO-OH adduct, MDA, and 4-hydroxyalkenals. These results support the current concept that free radical production following traumatic brain injury may induce lipid peroxidation and may be the direct cause of edema formation.

[Evaluation of effective treatment drugs against Acanthamoeba cyst]

Cysts of 2 isolates of Acanthamoeba from the cornea of 2 patients with confirmed Acanthamoeba keratitis were tested in vitro for sensitivity to antimycotic agents such as fluconazole, miconazole, amphotericin-B, pimaricin, antiprotozoal agents such as pentamidine isetionate and antiseptics which could be use in the ophthamological region. Pimaricin was the most successful cysticidal agent against the two strains. Sensitivity to pentamidine isetionate showed variation. Fluconazole, miconazole and amphotericin-B were resistant against cysts with concentration of eye drops that have been used in the treatment of Acanthamoeba keratitis. It was supposed that 5% pimaricin eye drops could be use in the treatment of Acanthamoeba keratitis in addition to keratomycosis. Pentamidine isetionate which belong to the diamidine family, is not yet clear as to the side effects to corneal epithelium cell, but we believe that this drug could be expected as a new therapeutic agent for Acanthamoeba keratitis.

Proton MR spectroscopy of delayed cerebral radiation in monkeys and humans after brachytherapy

PURPOSE

To determine whether radiation necrosis can be differentiated from residual/recurrent tumor by proton MR spectroscopy.

METHODS

We studied the effects of interstitial brachytherapy on the brains of healthy monkeys and in humans with glioblastoma multiforme. The effects of radiation therapy on normal brain tissue in monkeys were assessed with sequential proton MR spectroscopic studies 1 week to 6 months after brachytherapy. Proton MR spectroscopy was also performed in five patients with residual/recurrent glioblastoma multiforme (three of whom had radiation necrosis after brachytherapy), seven patients with newly diagnosed untreated glioblastoma multiforme, and 16 healthy volunteers, who served as a control group.

RESULTS

In monkeys, the ratio of N-acetylaspartate (NAA) to creatine-phosphocreatine (Cr) and the ratio of choline-containing compounds (Cho) to Cr of the reference point were significantly lower 1 week after brachytherapy than before treatment. The ratio of NAA to Cho of the irradiated area tended to be higher 1 week after brachytherapy than before irradiation. These peak metabolic ratios showed characteristic changes 6 months after treatment. In two of three monkeys, lipid signal was elevated 6 months after irradiation. In the clinical study, the ratio of NAA to Cho in the area of radiation necrosis was significantly different from that in glioblastoma multiforme when compared with the contralateral hemisphere after irradiation. In addition, lipid signal was detected in all patients with radiation necrosis.

CONCLUSION

It might be possible to use proton MR spectroscopy to differentiate radiation necrosis from residual/recurrent glioblastoma multiforme on the basis of comparisons with the contralateral hemisphere after radiation therapy.

Effects of lecithinized superoxide dismutase on traumatic brain injury in rats

Only small amounts of superoxide dismutase (SOD) are present in the extracellular space to scavenge excess amounts of superoxide anions (02-) released after traumatic brain injury (TBI). Experiments were performed in rats with cerebral contusion produced by weight-drop technique. We investigated the effects of exogenous lecithinized SOD (PC-SOD) on accumulation of 02- produced in our model, by measuring the level of SOD activity (using the NBT-reducing method) and the expression of copper, zinc-SOD (Cu, Zn-SOD) mRNA (by Northern blot analysis). As determined by tissue-specific gravity, administration of PC-SOD reduced brain edema in the periphery of the lesion 6 h after contusion. SOD activity increased in the peripheral region at 30 min after contusion, but returned to normal levels at 6 h after TBI. Administration of PC-SOD increased SOD activity up to 6 h after TBI. The expression of Cu, Zn-SOD mRNA increased in the core region, peripheral portion, and contralateral hemisphere up to 6 h after TBI, then was suppressed in all three regions by PC-SOD. Our results confirm the important role of 02- in the development of brain edema after TBI and indicate that PC-SOD diminishes brain edema through a protective effect against 02-.

Evaluation of intracerebral grafting of dopamine-secreting PC12 cells into allogeneic and xenogeneic brain

The PC12 phenochromocytoma tumor cell line is derived from a rat adrenal medullary tumor and secretes dopamine. We have previously reported that grafted microencapsulated PC12 cells using agarose and poly (styrene sulfonic acid) survived in the xenogeneic brain without immunosuppression. To investigate whether unencapsulated PC12 cells form a tumor and how they provoke immunological reaction, PC12 cell suspension was implanted into the striatum of Sprague-Dawley rat (allogeneic graft) or guinea pig (xenogeneic graft) and histological analysis using Nissl stain and immunocytochemical analysis using antityrosine hydroxylase (TH) antibody were performed 1, 2, and 4 wk after transplantation. Host animals were not immunosuppressed. PC12 cells formed a mass 1 and 2 wk after transplantation both in allogeneic and xenogeneic brain. These grafted PC12 cells were immunoreactive to anti-TH antibody. Four weeks after transplantation, however, grafted PC12 cells in the allogeneic brain were only found within the restricted area near the site of implantation. In the xenogeneic brain, only the trace of grafted PC12 cells were found around the site of implantation 4 wk after transplantation. In both allogeneic and xenogeneic animals, a number of lymphocytes were found in and around the grafts at all period investigated. These findings indicate that PC12 cells could survive in the allogeneic or xenogeneic brain for 2 wk and were ultimately rejected by immunological reaction by 4 wk after transplantation. Implantation of encapsulated PC12 cells in the allogeneic or xenogeneic brain is considered a safe and effective method for delivering dopamine into the brain because PC12 cells will not form a tumor in the long-term even if capsules are damaged in some reason.

Three-dimensional analysis of vasospastic major cerebral arteries in rats with the corrosion cast technique

BACKGROUND AND PURPOSE

Although mice, rats, and other small animals are commonly used for molecular biology research, their use in the evaluation of cerebral vasospasm after subarachnoid hemorrhage is somewhat problematic because of the correspondingly small size of their cerebral vessels. We have already reported that the corrosion cast technique was useful for evaluating newly formed cerebral vessels in neural grafts in these small animals. In the present study we applied the corrosion cast technique to the evaluation of hemolysate-induced cerebral vasospasm in rats and performed three-dimensional analysis for comparison. The casting was done 10 minutes after the hemolysate injection, so that only acute "vasospasm" was assessed.

METHODS

After withdrawal of 0.1 mL cerebrospinal fluid, 0.2 mL hemolysate (n = 9) or saline (n = 10) was injected into the cisterna magna of male Sprague-Dawley rats weighing between 300 and 350 g. Ten minutes later, perfusion of a semipolymerized casting medium was performed at an injection pressure of 100 to 120 mm Hg. The brains were immersed and corroded in 10% NaOH solution. After these procedures, the basilar artery as well as peripheral vessels was analyzed morphologically with scanning electron microscopy. Conventional histological analysis with the use of paraffin-embedded section with hematoxylin-eosin staining was also performed, and the results were compared with those for the corrosion cast methods.

RESULTS

In the saline-injected group, SEM showed that the inner surface of the basilar artery was smooth and the form of the endothelial cell was printed on the surface of the cast. In the hemolysate-injected group, the basilar artery showed an apparent vasospasm over its entire length, and corrugation was observed on the inner surface of the basilar artery in a three-dimensional fashion. Higher magnification revealed that the nuclei of the endothelial cells were distorted. Local narrowing of the basilar artery and vasospasm in the arteries of the anterior circulation and in peripheral arteries were also observed. Measurement of the inner diameter of the basilar artery showed 37.8% contraction in the hemolysate-injected group compared with the saline-injected group by the corrosion cast method. This degree of vasospasm was similar to that observed by the conventional histological method.

CONCLUSIONS

In this report we show that detailed three-dimensional observation in the rat can be performed qualitatively and quantitatively with the corrosion cast technique. We conclude that this method derives an accurate measurement of the diameter of rat major cerebral arteries and is more reliable for analyzing vasospasm in rats than angiography and other conventional procedures.

[Motor functional MRI by spiral scan--compared with GRE]

Recently, functional MRI (fMRI) has been performed in two methods using 1.5 tesla machine. One was performed using gradient recalled echo (GRE), the other was performed using echo planner imaging (EPI). There is a third method for fMRI called spiral scan. This method is applicable without strong gradient magnetic field such as required by EPI. In this study, motor fMRI was performed in ten normal volunteers by both spiral scan and GRE. Less than 1% risk (t-test), spiral scan showed the reactive area more clearly than GRE. And GRE showed higher signal intensity changing ratio than spiral scan, but there was no significant difference between spiral scan and GRE. The acquisition time of spiral scan was 2 seconds per image, and that of GRE was 10.5 seconds. Spiral scan has good temporal resolution and contrast-noise ratio. These are very advantageous for fMRI.

[Preservation of olfaction in frontal transbasal approach]

Lesions in the frontal base and clival area have conventionally been approached using the transbasal approach described by Derome and Guiot. However, this approach necessitates removal of the crista galli and sectioning of the olfactory rootlets with the associated risk of anosmia and cerebrospinal fluid leak and, in addition, complex reconstruction of the frontal base is required. We describe a new approach to deeply situated tumors in the frontal base, parasellar and clival area which is a modification of Spetzler's craniofacial approach with preservation of olfaction. In this approach, circumferential osteotomy cuts are made around the cribriform plate to permit en block removal with its attachment to both the dura and underlying mucosa. Opening of the dura is avoided and the cribriform bone is used to reconstruct the frontal base. Three patients underwent surgery using this approach for treatment of recurrent pituitary adenoma in two cases and for clivus chordoma in one. In one patient, olfactory function was not preserved because resection of nasal mucosa was small. In the other two patients, however, olfaction was preserved by creating a cribriform plate complex with a sufficient area of resection of nasal mucosa and tumors were completely removed. Olfaction can be preserved, CSF leakage can be prevented, and facial skin incision and complex frontal base reconstruction can be avoided when this technique for maintaining normal olfactory-cribriform anatomy is used in frontal transbasal approaches.

[Transient mutism after resection of left frontal lobe astrocytoma in adult: case report]

We reported a case of a 32-year-old female who had a transient mutism after resection of a malignant astrocytoma in the left frontal lobe. Preoperatively magnetic resonance (MR) imaging revealed a cystic tumor in the left frontal lobe. The patient underwent surgery. She was alert but did not speak immediately after surgery. She could follow verbal commands, comprehend written language, and write letters. She had no cranial nerve or extremity paresis. Seven days postoperatively, she began to say simple words, and one month postoperatively she could talk normally. Postoperative MR imaging revealed a hypointensity area on T1 weighted image in the frontal lobe including a part of the anterior cingulate cortex and the anterior part of the corpus callosum. It appears that a dominant hemisphere lesion of both the anterior cingulate cortex and the corpus callosum may be responsible for the development of postoperative mutism.

Role of extracellular matrix in experimental vasospasm. Inhibitory effect of antisense oligonucleotide on collagen induction

BACKGROUND AND PURPOSE

Although it has been suggested that collagen plays a role in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage, there has been no constructive research to prove it directly. In this study we stopped the transcription of the procollagen type I gene by introducing antisense oligonucleotides for its mRNA in a rat femoral artery model of vasospasm induced by blood and assayed the changes in the vasoconstrictive activity of the vessel and expression of the procollagen mRNA.

METHODS

We applied antisense, sense, or missense oligonucleotides, located at the carboxyl propeptide region for alpha 1(I) procollagen mRNA, onto the femoral artery in a rat femoral artery model of vasospasm. The diameter of the artery was measured by angiography. The transcription level of the procollagen gene in the arterial tissue was assayed by use of reverse transcription-polymerase chain reaction. Morphological change in the artery was observed with aldehyde-fuchsin-Masson-Goldner staining.

RESULTS

In the model, when the artery was exposed to antisense oligonucleotides in pluronic gel for 5 days to prevent arterial contraction, the contraction was inhibited at a significant level (76.0% +/- 5.6) when compared with that in control experiments using sense oligonucleotides (64.0% +/- 2.4), missense oligonucleotides (63.5% +/- 3.5), or gel alone (62.1% +/- 5.8). The application of antisense oligonucleotide resulted in a marked decrease in alpha 1(I) procollagen mRNA expression as determined by polymerase chain reaction, indicating that the collagen reduction by antisense oligonucleotides occurred at the transcription level. Histological staining suggested that collagen accumulation at the site in the artery where antisense oligonucleotide had been administered was indeed less than that in the control artery.

CONCLUSIONS

The results indicate that the induction of procollagen type 1 could cause pathogenesis of the arterial contraction induced by blood in a rat femoral vasospasm model.

Inhibition of vascular contraction by intracisternal administration of preproendothelin-1 mRNA antisense oligoDNA in a rat experimental vasospasm model

To clarify the role of endothelin-1 (ET-1) in the etiology of hemolysate-induced contraction of vessels, the authors introduced antisense oligoDNA for preproendothelin-1 (ppET-1) messenger RNA in a rat model of vasospasm. Phosphorothioate antisense oligoDNAs for ppET-1 were injected into the cisterna magna. Fluorescein isothiocyanate-labeled phosphorothioate antisense oligoDNAs were proven by fluorescence chasing to be incorporated into the vascular wall. Striking inhibitory effects of experimental vasospasm were observed in the basilar artery (BA) in which the oligoDNAs were injected. The vascular contraction was significantly inhibited by oligoDNAs after 20 minutes of hemolysate exposure, which suggested that ET synthesis started approximately 20 minutes after hemolysate stimulation. Expression of ppET-1 in the BA in which the spasm was inhibited was markedly suppressed at the transcription level. The results indicate that ET-1 may play an important role in hemolysate-induced vasoconstriction in rats. In addition, the antisense approach in the cerebrospinal fluid might be a useful tool for preventing cerebral vasospasm.

Preliminary report of polymer-encapsulated dopamine-secreting cell grafting into the brain

Polymer-encapsulated dopamine-secreting cell grafting is one of the most promising approaches for the treatment of Parkinson's disease. We microencapsulated dopamine secreting PC12 cells into agarose/poly(styrene sulfonic acid) complex and grafted them into the xenogeneic brain without immunosuppression. Dopamine secretion from the encapsulated cells was confirmed by high-performance liquid chromatography (HPLC) analysis before grafting. A large number of encapsulated PC12 cells survived in the brain 1 mo after transplantation and these cells were immunoreactive to tyrosine hydroxylase (TH) antibody, suggesting that these cells were secreting dopamine into the brain. There was no apparent immunological rejection or tumor formation. We concluded that microencapsulated PC12 cells survive in the xenogeneic brain without immunosuppression, and this grafting procedure is expected to be applied for the treatment of Parkinson's disease in the near future in combination with stereotaxic thalamotomy or pallidotomy.

The relationship between brain surface elastance and brain reexpansion after evacuation of chronic subdural hematoma

BACKGROUND

Brain stiffness has been thought to be a factor affecting brain re-expansion after the evacuation of chronic subdural hematoma.

METHODS

As an index of brain stiffness, the pressure for compressing the brain using an ophthalmodynamometer was defined as brain-surface elastance. This elastance in 14 patients was measured and analyzed in relation to brain re-expansion.

RESULTS

Patients with an enlarged subdural space on computed tomography 1 month after the operation had higher elastance. There was a correlation between high elastance and high age.

CONCLUSIONS

Measuring the elastance after evacuation of the hematoma may help predict the persistence of a subdural space.

Chromaffin cell survival and host dopaminergic fiber recovery in a patient with Parkinson's disease treated by cografts of adrenal medulla and pretransected peripheral nerve. Case report

A 55-year-old woman with severe Parkinson's disease was treated by cografting adrenal medulla with pretransected peripheral nerve into the bilateral caudate nuclei. The patient showed modest improvement of her akinesia; this effect persisted for 1 year after transplantation, when she suddenly died from upper gastrointestinal bleeding unrelated to the grafting procedure. At autopsy, a large number of tyrosine hydroxylase-immunoreactive chromaffin cells were observed within the caudate graft sites and a dense network of host dopaminergic fibers was visualized. This autopsy finding is very important for the field of experimental and clinical chromaffin cell grafting because it is the first evidence that cografts using pretransected peripheral nerve might enhance the survival of chromaffin cells and the recovery of host dopaminergic fibers in humans suffering from Parkinson's disease.

[Encapsulated dopamine-secreting cells transplanted into the brain: a possible therapy for Parkinson's disease]

Encapsulation of neurosecretory cells within a semipermeable membrane may possibly isolate the enclosed cells from the host immune system and allow inward diffusion of nutrients and outward diffusion of neurotransmitters. Moreover, the encapsulation procedure may prevent the tumor formation of enclosed cells, when they are derived from tumor cells. In the present study, PC12 cells, a dopaminergic cell line derived from a rat pheochromocytoma, were enclosed within an agarose/poly (styrene sulfonic acid) (agarose/PSSa) mixture and transplanted into the brains of rats (allogeneic transplantation) or guinea pigs (xenogeneic transplantation). Tyrosine hydroxylase (TH) immunoreactive PC12 cells within the microcapsules were observed in all rats and guinea pigs at least up to five weeks after transplantation. PC12 cells were round in shape and of relatively uniform small size. Although PC12 cells occasionally formed cell clusters, the formation of a tumor was not observed. The host reaction to agarose/PSSa microcapsules was minimum. The degree of glial fibrillary acidic protein (GFAP) positive astrocyte density around the microcapsules was similar to that around injection tracks. There was no apparent immunological rejection around the capsules. High-performance liquid chromatography with electrochemical detection (HPLC-EC) showed basal and potassium-evoked release of dopamine from the PC12 cell-enclosed microcapsules in vitro. Although our data is preliminary, we believe that agarose/PSSa microcapsules are promising for producing semipermeable membranes that enable allo-and xenotransplantation of neurosecretory cells into the brain in the absence of systemic immunosuppression. This approach is expected to be applied in Parkinson's disease in the near future.

[Clinical usefulness of microparticle enzyme immunoassay for HBeAg and HBeAb in chronic hepatitis B patients]

A study was made of 73 samples from 6 chronic hepatitis B patients, 2 out of the 6 cases were non-treated and the 4 cases were interferon treated HBeAg, HBeAb, s-ALT and HBV-DNA. Detection of HBeAg and HBeAb were assayed by AxSYM system (Dainabot), which were based on microparticle enzyme immunoassay. 1) Fifty-three out of 73 samples showed positive for HBeAg; 45 samples showed only HBeAg positive (Group A) and 8 samples showed HBeAg and HBeAb positive (Group B). The positive ratios of HBV-DNA in each group 91.1% (41/45) and 50.0% (4/8), respectively and 4 out of the rest 20 samples that showed only HBeAb positive also showed HBV-DNA positive. The above 12 discrepant samples between HBeAg and HBV-DNA were collected from 4 chronic hepatitis B patients who became normal s-ALT levels after liver injury. The HBeAg S/N ratio (sample/negative control) of these samples were near the cutoff value (S/N = 2.1). 2) Comparing the movement between HBeAg and s-ALT levels in 6 chronic hepatitis B patients, the changes of HBeAg S/N ratio were related with the changes of s-ALT. The changes of HBeAg S/N ratio were observed before the movement of s-ALT. In conclusion, the detection of HBeAg/HBeAb by AxSYM system was useful to monitor the clinical course of chronic hepatitis B patients.

[Change of hepatitis B surface antigen in serum from patients with chronic hepatitis B]

To study the clinical significance of hepatitis B surface antigen (HBsAg) levels in chronic hepatitis B, sera from five patients with chronic hepatitis B HBsAg levels were measured quantitatively by counting immunoassay (CIA). CIA is an immunoassay that combines the latex agglutination method and particle counting technique. The results were as follow: 1) In four patients with chronic active hepatitis, the increases of HBsAg levels were earlier than that of alanine aminotransferase levels, and HBsAg levels had approximately the same changes as hepatitis B virus associated DNA polymerase (HBV DNA-p) activities. 2) In four patients treated with interferon-alpha or beta, HBsAg levels after treatment decreased in the same manner as HBV DNA-p activities. 3) In a patient with chronic inactivate hepatitis. HBsAg levels were the same changes as HBV DNA-p activities. These results suggested that quantitative analysis of HBsAg levels is useful to evaluate the prognosis and exacerbation for chronic hepatitis B.

Two-year follow-up study of a patient with Parkinson's disease and severe motor fluctuations treated by co-grafts of adrenal medulla and peripheral nerve into bilateral caudate nuclei: case report

We performed co-grafts of adrenal medulla and peripheral nerve into the bilateral caudate nuclei of a 43-year-old patient with advanced Parkinson's disease who showed severe daily motor fluctuations before surgery. There were no postoperative complications, and a 2-year follow-up result is presented. The patient showed a gradual and significant amelioration of the parkinsonian symptoms starting 2 weeks after transplantation. The alleviation of akinesia during "off" periods was the most apparent clinical improvement and continued for 2 years after surgery. The dosage of L-dopa/benserazide was significantly reduced after surgery compared with that before surgery. The results indicate that co-grafts of adrenal medulla with peripheral nerve may be useful for the treatment of Parkinson's disease in the long term.

Expression of Cu,Zn-superoxide dismutase mRNA after cold and contusion injury in the rat brain

We analyzed the expression of Cu,Zn-superoxide dismutase (SOD) mRNA in both contusion and cold injury. Twenty-three rats were divided into 3 groups: a control group, a contusion group, and a cold injury group. Six hours after the injury, the rats were decapitated and the gray matter was resected from 3 portions: the core of the injured cortex, its periphery, and a distal portion on the non-lesion side. Based on the specific gravity of each sample, almost the same degree of edema developed in both injury groups. The mRNA expression in the cold injury group, however, significantly decreased in all portions. The extremely low temperature associated with cold injury is a possible cause of the decrease in Cu,Zn-SOD mRNA.

Meningiomas arising from the falcotentorial junction. Clinical features, neuroimaging studies, and surgical treatment

Meningiomas arising from the falcotentorial junction are extremely rare. The authors describe the clinical features, neuroimaging studies, and results of surgical treatment of meningiomas of the falcotentorial junction and clarify the characteristics of this lesion based on a review of the literature and seven patients treated at their institution. The most common symptoms resulted from intracranial hypertension. Upward-gaze palsy appeared in only one patient. Computerized tomography (CT) showed no specific findings, but there was no evidence of edema around the tumor. Magnetic resonance (MR) imaging revealed a round, smooth-bordered mass with a peritumoral rim, without edema, and showing marked contrast enhancement. The multiplanar capability of MR imaging delineated the relationship between the tumor and adjacent structures better than did CT. Detailed knowledge of the vascular structures, especially evidence of occlusion of the galenic venous system and the development of collateral venous channels, is critical for successful surgery; stereoscopic cerebral angiography is necessary to achieve this aim. The seven patients described developed five types of collateral venous channels: through the basal vein of Rosenthal to the petrosal vein, through the veins on the medial surface of the parietal and occipital lobes to the superior sagittal sinus, through superficial anastomotic veins, through veins of the posterior fossa to the transverse or straight sinus, and through the falcian veins to the superior sagittal sinus. The first three types mainly developed after occlusion of the galenic system. The tumors were removed through the occipital transtentorial approach with a large window at the posterior part of the falx. A favorable prognosis for patients undergoing surgical treatment of falcotentorial junction meningiomas can be expected if detailed neuroimaging studies and microsurgical techniques are used.