Search for the Majorana Nature of Neutrinos in the Inverted Mass Ordering Region with KamLAND-Zen

The KamLAND-Zen experiment has provided stringent constraints on the neutrinoless double-beta (0νββ) decay half-life in ^{136}Xe using a xenon-loaded liquid scintillator. We report an improved search using an upgraded detector with almost double the amount of xenon and an ultralow radioactivity container, corresponding to an exposure of 970 kg yr of ^{136}Xe. These new data provide valuable insight into backgrounds, especially from cosmic muon spallation of xenon, and have required the use of novel background rejection techniques. We obtain a lower limit for the 0νββ decay half-life of T_{1/2}^{0ν}>2.3×10^{26}  yr at 90% C.L., corresponding to upper limits on the effective Majorana neutrino mass of 36-156 meV using commonly adopted nuclear matrix element calculations.

Impact of small-airway disease on exercise intolerance and long-term outcomes in patients with heart failure and reduced or preserved ejection fraction

Introduction

Exercise intolerance in patients with heart failure (HF) is a strong indicator of a poor prognosis. As the respiratory impairment in HF patients, the small airway is reportedly more susceptible than central airways, which results in increased airway resistance and may cause poor outcomes. However, the impact of small-airway disease (SAD) on exercise intolerance and prognosis in patients with HF is still unclear.

Purpose

We investigated the associations between SAD and exercise intolerance in patients with HF, and the clinical significance of SAD for long-term clinical events with a reduced or preserved ejection fraction.

Methods

We reviewed 1015 patients with HF (mean age, 66.9±14.6 years; male, 64.5%) admitted for medical treatment. Patients with a prior history of chronic respiratory disease or an obstructive lung pattern – defined as the forced expiratory volume (%) in 1 s relative to <70% forced vital capacity using spirometry – were excluded. Characteristics including HF aetiology, comorbidities conditions, medications, blood parameters, and echocardiographic variables were obtained from clinical records. All patients underwent spirometry at hospital discharge, and SAD was defined as the maximum mid-expiratory flow (%) relative to a <60% predicted value. At hospital discharge, we measured 6-min walk distance (6MWD), and <300 m was considered as exercise intolerance. The primary endpoint was a composite clinical event of all-cause death and/or unplanned readmission for HF. Multivariate logistic regression analysis was used to assess the association between SAD and exercise intolerance. The multivariate Cox proportional hazard model was used to clarify whether SAD was an independent predictor for the incidence of clinical events. We also performed subgroup analyses in each multivariate analysis based on a left ventricular ejection fraction (LVEF) of 40%.

Result

SAD was observed in 479 (47.2%) patients. LVEF subgroups included 458 (45.1%) and 518 (51.0%) patients with LVEF <40% and ≥40%, respectively. After adjusting for clinical characteristics, SAD was independently associated with 6MWD <300 m (Figure 1). Moreover, this association was consistently observed in the LVEF <40% and ≥40% (Figure 1). During the median follow-up period of 1.5 years, all-cause death/readmission occurred in 431 patients (42.5%), and the incidence rate was 17.5/100 person-years. In the multivariate Cox proportional hazard model, SAD was independently associated with lower event-free survival rates in all patients and the LVEF <40% subgroup, but not LVEF ≥40% subgroup (Figure 2A, B, and C, respectively).

Conclusion

This study is the first to reveal that SAD is associated with exercise intolerance in patients with HF regardless of LVEF. Moreover, SAD may have a predictive significance for long-term outcomes in patients with HF and subgroups with reduced, but not preserved ejection fraction.

Funding Acknowledgement

Type of funding sources: None.

Precision Analysis of the ^{136}Xe Two-Neutrino ββ Spectrum in KamLAND-Zen and Its Impact on the Quenching of Nuclear Matrix Elements

We present a precision analysis of the ^{136}Xe two-neutrino ββ electron spectrum above 0.8 MeV, based on high-statistics data obtained with the KamLAND-Zen experiment. An improved formalism for the two-neutrino ββ rate allows us to measure the ratio of the leading and subleading 2νββ nuclear matrix elements (NMEs), ξ_{31}^{2ν}=-0.26_{-0.25}^{+0.31}. Theoretical predictions from the nuclear shell model and the majority of the quasiparticle random-phase approximation (QRPA) calculations are consistent with the experimental limit. However, part of the ξ_{31}^{2ν} range allowed by the QRPA is excluded by the present measurement at the 90% confidence level. Our analysis reveals that predicted ξ_{31}^{2ν} values are sensitive to the quenching of NMEs and the competing contributions from low- and high-energy states in the intermediate nucleus. Because these aspects are also at play in neutrinoless ββ decay, ξ_{31}^{2ν} provides new insights toward reliable neutrinoless ββ NMEs.

VALIDATION OF MONTE CARLO DOSE CALCULATION FOR PAEDIATRIC CT EXAMINATIONS USING TUBE CURRENT MODULATION BASED ON IN-PHANTOM DOSIMETRY

The aim of this study is to estimate tube current modulation (TCM) profiles in paediatric computed tomography (CT) examinations with a TCM scheme (Volume-EC) and evaluate the estimation accuracy of TCM profiles. Another aim is to validate organ doses calculated using Monte Carlo-based CT dosimetry software and estimated TCM profiles by comparing them with those measured using 5-year-old and 10-year-old anthropomorphic phantoms and radio-photoluminescence glass dosemeters. Dose calculations were performed by inputting detailed descriptions of a CT scanner, scan parameters and CT images of the phantoms into the software. Organ doses were evaluated from the calculated dose distribution images. Average relative differences (RDs) between the estimated and actual TCM profiles ranged from -3.6 to 5.6%. RDs between the calculated and measured organ doses ranged from -4.2 to 13.0% and -18.1 to 4.9% for 5-year-old and 10-year-old phantoms, respectively. These results validate dose calculations for paediatric CT scans using TCM.

Organ Dose Evaluations Based on Monte Carlo Simulation for CT Examinations Using Tube Current Modulation

The aims of this study were to estimate tube current values for each X-ray projection angle used in adult chest computed tomography (CT) and abdomen-pelvis CT examinations with tube current modulation (TCM) and to validate organ doses determined using Monte Carlo (MC) simulations through comparisons with the doses measured using in-phantom dosimetry. For dose simulations, dose distribution images were obtained by inputting the geometry of a CT scanner, scan parameters including estimated TCM curves and CT images of an adult anthropomorphic phantom into MC simulation software. Organ doses were then determined from the dose distribution images. For dose measurements, organ doses were evaluated using radio-photoluminescence glass dosemeters located at various organ positions within the phantom. Relative differences between the simulated and measured organ doses were -2.5 to 11.0% and -1.5 to 10.5% for organs in chest and abdomen-pelvis CT scan ranges, respectively. Thus, the simulated and measured doses agreed well.

DEVELOPMENT OF AGE-SPECIFIC JAPANESE PHYSICAL PHANTOMS FOR DOSE EVALUATION IN INFANT CT EXAMINATIONS

Secondary to the previous development of age-specific Japanese head phantoms, the authors designed Japanese torso phantoms for dose assessment in infant computed tomography (CT) examinations and completed a Japanese 3-y-old head-torso phantom. For design of age-specific torso phantoms (0, 0.5, 1 and 3 y old), anatomical structures were measured from CT images of Japanese infant patients. From the CT morphometry, it was found that rib cages of Japanese infants were smaller than those in Europeans and Americans. Radiophotoluminescence glass dosemeters were used for dose measurement of a 3-y-old head-torso phantom. To examine the validity of the developed phantom, organ and effective doses by the in-phantom dosimetry system were compared with simulation values in a web-based CT dose calculation system (WAZA-ARI). The differences in doses between the two systems were <20 % at the doses of organs within scan regions and effective doses in head, chest and abdominopelvic CT examinations.

Publisher's Note: Search for Majorana Neutrinos Near the Inverted Mass Hierarchy Region with KamLAND-Zen [Phys. Rev. Lett. 117, 082503 (2016)]

This corrects the article DOI: 10.1103/PhysRevLett.117.082503.

Search for Majorana Neutrinos Near the Inverted Mass Hierarchy Region with KamLAND-Zen

We present an improved search for neutrinoless double-beta (0νββ) decay of ^{136}Xe in the KamLAND-Zen experiment. Owing to purification of the xenon-loaded liquid scintillator, we achieved a significant reduction of the ^{110m}Ag contaminant identified in previous searches. Combining the results from the first and second phase, we obtain a lower limit for the 0νββ decay half-life of T_{1/2}^{0ν}>1.07×10^{26}  yr at 90% C.L., an almost sixfold improvement over previous limits. Using commonly adopted nuclear matrix element calculations, the corresponding upper limits on the effective Majorana neutrino mass are in the range 61-165 meV. For the most optimistic nuclear matrix elements, this limit reaches the bottom of the quasidegenerate neutrino mass region.

Optimised paediatric CT dose at a tertiary children's hospital in Japan: a 4-y single-centre analysis

Since diagnostic reference levels (DRLs) for children are not currently established in Japan, the authors determined local DRLs for the full range of paediatric CT examinations in a single tertiary care children's hospital. A retrospective review of 4801 CT performance records for paediatric patients (<15 y old) who had undergone CT examinations from 2008 to 2011 was conducted. The most frequent examinations were of the head (52 %), followed by cardiac (15 %), temporal bone (9 %), abdomen (7 %), chest (6 %) and others (11 %). Approximately one-third of children received two or more CT scans. The authors' investigation showed that mean CTDIvol and DLP for head, chest and abdomen increased as a function of age. Benchmarking of the results showed that CTDIvol, DLP and effective dose for chest and abdomen examinations in this hospital were below average, whereas those for the head tended to be at or slightly above average of established DRL values from five countries. The results suggest that CT examinations as performed in a tertiary children's hospital in Japan are well optimised.

Evaluation of organ doses in adult and paediatric CT examinations based on Monte Carlo simulations and in-phantom dosimetry

The aim of this study was to validate the computed tomography dose index (CTDI) and organ doses evaluated by Monte Carlo simulations through comparisons with doses evaluated by in-phantom dosimetry. Organ doses were measured with radio-photoluminescence glass dosemeter (RGD) set at various organ positions within adult and 1-y-old anthropomorphic phantoms. For the dose simulations, the X-ray spectrum and bow-tie filter shape of a CT scanner were estimated and 3D voxelised data of the CTDI and anthropomorphic phantoms from the acquired CT images were derived. Organ dose simulations and measurements were performed with chest and abdomen-pelvis CT examination scan parameters. Relative differences between the simulated and measured doses were within 5 % for the volume CTDI and 13 % for organ doses for organs within the scan range in adult and paediatric CT examinations. The simulation results were considered to be in good agreement with the measured doses.

Development of age-specific Japanese head phantoms for dose evaluation in paediatric head CT examinations

In this study, the authors developed age-specific physical head phantoms simulating the physique of Japanese children for dose evaluation in paediatric head computed tomography (CT) examinations. Anatomical structures at 99 places in 0-, 0.5-, 1- and 3-y-old Japanese patients were measured using DICOM viewer software from CT images, and the head phantom of each age was designed. For trial manufacture, a 3-y-old head phantom consisting of acrylic resin and gypsum was produced by machine processing. Radiation doses for the head phantom were measured with radiophotoluminescence glass dosemeters and Si-pin photodiode dosemeters. To investigate whether the phantom shape was suitable for dose evaluation, organ doses in the same scan protocol were compared between the 3-y-old head and commercially available anthropomorphic phantoms having approximately the same head size. The doses of organs in both phantoms were equivalent. The authors' designed paediatric head phantom will be useful for dose evaluation in paediatric head CT examinations.

Monitoring of T-cell repertoire was useful for predicting graft-versus-host disease prognosis in a patient with chronic myelogeneous leukemia after allogeneic bone marrow transplantation

We analyzed 24 T-cell receptor (TCR)beta chain subfamilies (Vbeta) and the chimerism of a patient with chronic myelogeneous leukemia who underwent allogeneic bone marrow transplantation (allo-BMT). The patient developed liver dysfunction at day 19 leading to worsening of his condition. He died on day 91 of hepatic failure. Complete donor chimerism was observed after day 19. The average complexity score of TCR-Vbeta, which was low on day 19 (5.50), because much lower on day 82 (3.77). The average value of normal volunteers is 7.69. Neither immunosuppressive therapy nor antiviral therapy was effective to treat his hepatic dysfunction. A liver specimen at autopsy showed necrotic tissue with invasion of lymphocytes under the endothelial cells of the bile ducts. These findings suggest that the liver dysfunction was due to graft-versus-host disease (GVHD). Careful monitoring of chimerism and TCR-Vbeta complexity may help to predict the prognosis of GVHD after allogeneic BMT.

Successful non-T-cell-depleted nonmyeloablative hematopoietic stem cell transplantation (NST) from an HLA-haploidentical 2-loci-mismatched sibling in a heavily transfused patient with severe aplastic anemia based on the fetomaternal microchimerism

A 37-year-old Japanese man with systemic hemochromatosis due to multiple transfusions was referred to us for the treatment of severe aplastic anemia (SAA), from which he had been suffering for 24 years. The patient had diabetes arising from the hemochromatosis, chronic anal fissures, and a kidney abscess due to neutropenia. He was treated with a nonmyeloablative preconditioning regimen followed by non-T-cell-depleted (non-TCD) allogeneic peripheral blood stem cell transplantation (PBSCT) from his human leukocyte antigen (HLA)-haploidentical 2-loci-mismatched sibling. Prompt engraftment of granulocytes and platelets was observed, and graft-versus-host disease was easy to control. Noninherited maternal antigens in the donor were confirmed prior to PBSCT, and they were also detected in small quantities in the recipient. This report describes the first successful nonmyeloablative hematopoietic stem cell transplant in a heavily transfused SAA patient from an HLA-haploidentical 2-loci-mismatched sibling donor. The result suggests that a long-term fetomaternal microchimerism-positive sibling can be a second-line donor if an alternative HLA-identical donor is not available.

Possible efficacy of lamivudine treatment to prevent hepatitis B virus reactivation due to rituximab therapy in a patient with non-Hodgkin's lymphoma

We used regimens containing rituximab in the treatment of five hepatitis B virus surface antibody (HBsAb)-positive patients with non-Hodgkin's lymphoma (NHL). Serum levels of HBsAb were obtained and analyzed in four of these patients. Two patients were HBs antigen (HBsAg) positive. One of these HBsAg-positive patients was treated with lamivudine because the patient developed fulminant hepatitis from hepatitis B virus (HBV) infection prior to chemotherapy. However, none of the other patients were administered lamivudine. An HBsAg-positive patient who did not receive lamivudine treatment later developed fulminant hepatitis. Another HBsAg-positive patient receiving lamivudine prophylaxis did not develop severe hepatitis arising from HBV. In the three patients not receiving lamivudine treatment, serum HBsAb titers decreased soon after the administration of rituximab. These results suggest that rituximab reduced the antibody titer for HBV, thus inducing an immunological environment leading to easy reactivation of HBV. Lamivudine prophylaxis was effective, at least when rituximab was given to an HBsAg-positive patient with non-Hodgkin's lymphoma.

Treatment modalities for oral verrucous carcinomas and their outcomes: contribution of radiotherapy and chemotherapy

BACKGROUND

This clinical study focused, firstly, on the results of treatment and, secondly, on the anaplastic transformation, of oral verrucous carcinomas (OVCs) diagnosed and treated from 1981 to 1997 at the Department of Oral and Maxillofacial Surgery at Shimane Medical University Hospital.

METHODS

We analyzed the treatment modalities and outcomes for 15 patients with OVC.

RESULTS

Excluding the results for 4 palliatively treated patients, the disease-free survival rates of the patients after the initial treatments, were 82% at 5 years and 66% at 10 years; for all 15 patients, these rates were 57% and 46%, respectively. Surgery alone and surgery combined with other treatments (such as radiotherapy and chemotherapy) appeared to yield disease-free survival rates to those achieved superior with other treatments whether single or combined; (78% vs 33% for 5-year disease-free survival; 52% vs 33% for 10-year disease-free survival); however, the difference was not significant (P = 0.47). Well differentiated squamous cell carcinomas (W-SCCs) (n = 5) as well as spindle cell carcinoma (n = 1) were found in subsequent operative or biopsy specimens.

CONCLUSION

Surgery was the most reliable treatment method for OVC; however, radiotherapy combined with chemotherapy was the next most preferable treatment when surgery was not undertaken. We also found that highly malignant transformation (anaplastic transformation) occasionally occurred during treatments for OVC.

Anandamide induces apoptosis of PC-12 cells: involvement of superoxide and caspase-3

Anandamide (arachidonoylethanolamide), an endogenous cannabinoid receptor ligand has been suggested to have physiological role in mammalian nervous system. However, little is known about the role of anandamide on neuronal cells. Here, we demonstrate that anandamide causes death of PC-12 cells, showing marked DNA condensation and fragmentation, appearance of cells at sub-G(0)/G(1) and redistribution of phosphatidyl serine, the hallmark features of apoptosis. Anandamide raised intracellular superoxide level and CPP32-like protease activity in PC-12 cells markedly. Furthermore, antioxidant N-acetyl cysteine prevented anandamide-induced superoxide anion formation and cell death, implying that intracellular superoxide is a novel mediator of anandamide-induced apoptosis of PC-12 cells.

The effect of trihexyphenidyl, an anticholinergic agent, on regional cerebral blood flow and oxygen metabolism in patients with Parkinson's disease

Cerebral blood flow and oxygen metabolism were studied in six previously untreated patients with Parkinson's disease (PD) before and after anticholinergic treatment using positron emission tomography (PET) and compared with six controls. The PET study and an assessment of the disability and cognitive impairment were performed before and after administration of 6 mg trihexyphenidyl for 5 to 11 weeks. All PD patients showed improvements in motor symptoms after the trihexyphenidyl treatment. Cognitive function did not significantly differ between before and after trihexyphenidyl treatment. However, after trihexyphenidyl treatment, rCBF and rCMRO2 decreased by 15% in the striatum and by 10% in all cortical areas contralateral to predominantly symptomatic limbs, and by 10% in the ipsilateral striatum and all cortical areas, significantly below the values of controls in most cerebral cortices and striatum. These findings suggest that trihexyphenidyl inhibits the cortical cholinergic system and significantly decreases rCBF and rCMRO2 in the cerebral cortices without cognitive impairment in untreated patients with PD.

Suppression of transforming growth factor beta and vascular endothelial growth factor in diabetic nephropathy in rats by a novel advanced glycation end product inhibitor, OPB-9195

AIMS/HYPOTHESIS

Advanced glycation end products (AGEs) participate in the pathogenesis of diabetic nephropathy. We reported earlier that OPB-9195, a synthetic thiazolidine derivative and novel inhibitor of advanced glycation, prevented progression of diabetic glomerulosclerosis by lowering serum concentrations of advanced glycation end products and reducing their deposition in the glomeruli. Here, we examined their contribution and that of growth factors, such as transforming growth factor-beta (TGF-beta) and vascular endothelial growth factor (VEGF), to the progression of diabetic nephropathy. We also investigated the expression of type IV collagen in the kidneys of Otsuka-Long-Evans-Tokushima-Fatty (OLETF) rats, a Type II (non-insulin-dependent) diabetes mellitus model, after treatment with OPB-9195.

METHODS

Using northern blots and immunohistochemical techniques, we determined the renal expression of TGF-beta and type IV collagen mRNAs and proteins in OLETF rats. We also examined OPB-9195's effects on renal expression of VEGF mRNA and protein.

RESULTS

Concomitant increases in TGF-beta and type IV collagen expression were observed at each point in time in OLETF rats not given OPB-9195. In contrast, OPB-9195 treatment greatly suppressed the renal expression of TGF-beta, VEGF and type IV collagen mRNAs and proteins to that seen in non-diabetic rats.

CONCLUSION/INTERPRETATION

Since OPB-9195, an AGE-inhibitor, prevented the progression of diabetic nephropathy by blocking type IV collagen production and suppressing overproduction of two growth factors, TGF-beta and VEGF, in diabetic rats, this compound warrants further investigation.

A three-month repeated oral administration study of a low viscosity grade of hydroxypropyl methylcellulose in rats

The toxicity of the lowest viscosity grade of hydroxypropyl methylcellulose (HPMC) that is currently commercially available was investigated by means of a three-month repeated oral administration study in male and female Crj:CD (SD) IGS rats at doses of 505, 1,020 and 2,100 mg/kg/day. Body weights of males and females in the 2,100 mg/kg group were lower than those of the control group on and after day 28 of administration, but the differences were not statistically significant. The degree of suppression of body weight gain in males was higher than that in females. This tendency was similar to the results in other toxicity studies of HPMC that have been reported. Males in the 2,100 mg/kg group showed a tendency (not significant) for decreased food consumption and urine volume. Examinations of general signs, hematology, blood chemistry, ophthalmology, absolute and relative organ weights, autopsy and histopathology revealed only a few, apparently coincidental, statistically significant differences from the control, and no evidence of any dose-dependent changes was found. It was concluded that the lowest viscosity grade of HPMC showed extremely low toxicity under the conditions of this study, as has been found for higher viscosity grades.

Dry coating: an innovative enteric coating method using a cellulose derivative

A novel enteric coating method was developed. This method involves direct feeding of coating polymer powder and simultaneous spraying of plasticizing agent, without either organic solvent or water, using a centrifugal granulator, fluidized bed, or tablet-coating machine. For film formation, a curing step was then necessary; this involved spraying a small amount (3-8% of core weight) of water or hydroxypropyl methylcellulose solution, followed by heating. Hydroxypropyl methylcellulose acetate succinate was used as the enteric coating polymer, and a combination of triethyl citrate and acetylated monoglyceride was used for plasticization. The coated beads and tablets were evaluated for gastric resistance, intestinal disintegration, and stability, in comparison with beads and tablets from a conventional aqueous coating with the same enteric polymer. The new method required a higher coating amount for gastric resistance compared with the conventional coating, but the processing time was dramatically reduced. The results show that this dry coating method is applicable to the preparation of enteric-coated beads and tablets using commercially available lab-scale apparatus.

Application of extremely low viscosity methylcellulose (MC) for pellet film coating

Pellet film coating has very limited applicability compared with tablet film coating, because of the problem of sticking during fluidized bed operation. We have prepared an extremely low viscosity methylcellulose (MC) (4 mPa.s), and examined its solution and film properties and its suitability for pellet film coating. MC lost its adhesiveness at a relatively high moisture content and pellet film coating could be achieved without agglomeration of the pellets within a reasonable operating time. The coated pellets were covered with a continuous film of MC, and drug release from the coated pellets was as rapid as that from the core. These findings suggest that MC (4 mPa.s) is applicable for pellet film coating in an aqueous system.

Skin sensitization and photosensitization studies of hydrophobically modified hydroxypropyl methylcellulose in guinea pigs

Skin sensitization and photosensitization tests of hydrophobically modified hydroxypropyl methylcellulose (HM-HPMC), a new cellulose derivative used as a thickener for topical pharmaceuticals, were conducted using guinea pigs. An aqueous dispersion of HM-HPMC (3 w/v %) was applied in the tests. Skin reaction was not observed in any animal in the HM-HPMC-treated group or control group. In the photosensitization test, no skin reaction was found in any animal in the test-preparation group or the control group. It was concluded that HM-HPMC dispersion does not exhibit skin sensitizing or photosensitizing activity under the condition of this test.

Cerebral blood flow and oxygen metabolism before and after a stroke-like episode in patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS)

Cerebral blood flow and oxygen metabolism were examined in two patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) using positron emission tomography (PET). Regional cerebral blood flow (rCBF), regional cerebral oxygen metabolic rate (rCMRO2) and regional oxygen extraction fraction (rOEF) were determined with the steady-state technique using oxygen-15-labeled tracers (15O2, C15O2 and C15O). Case 1, a 45-year-old woman, presented with abrupt onset of fluent aphasia. T2-weighted magnetic resonance imaging (MRI) showed a high signal intensity lesion in the left temporoparietal region. The first PET study on day 16 showed increased rCBF and decreased rCMRO2 in the temporal region. In the second PET study, on day 35, rCBF in the temporal region had decreased. Case 2 was a 19-year-old male; the second son of Case 1. He complained of transient blurring of vision, and then generalized tonic-clonic convulsion occurred. A PET study six days before this stroke-like episode demonstrated increased rCBF in both frontal lobes and putamen, where MRI showed lesions after the episode. Focal hyperemia of the lesion antedated and lasted for at least sixteen days after the stroke-like episode in these MELAS patients. These stroke-like episodes appear to be the result of metabolic dysfunction in neural tissue, although the role of an ischemic vascular event cannot be ruled out.

Calcifying epithelioma (pilomatrixoma) of the head and neck: analysis of 37 cases

OBJECTIVE

To review all cases of pilomatrixoma (calcifying epithelioma) of the head and neck published in Japanese dental journals 1977-1994.

DESIGN

Retrospective review.

SETTING

University hospital, Japan.

SUBJECTS

37 Patients with 38 tumours, mean age 23 years, female: male ratio 2.4:1.

INTERVENTIONS

Enucleation alone (n=29, 78%), excision including covering skin (n=7, 19%), or excision including superficial lobe of parotid (n=1, 3%).

MAIN OUTCOME MEASURE

Presentation, site, recurrence, and histological features.

RESULTS

Two patients had multiple tumours (5%). Most of the tumours were firm nodules covered with normal skin varying in size from 5 to 30 mm. The most common site was the preauricular region; 22 (58%) were in the anterior part. The follow up period ranged from 7 to 43 months during which there was only one recurrence. Tumours were encapsulated and solid composed of either shadow and basophilic cells or shadow cells alone, and the stroma contained varying amounts of calcification, ossification, and keratinization.

CONCLUSIONS

The diagnosis should be suspected when the mass is adherent to the skin but not fixed to the underlying tissue. It is difficult to distinguish between benign and malignant tumours by imaging methods alone, so the recommended treatment must be complete excision including adherent skin.

Pharmacological properties of traditional medicines. XXIII. Searching for active compounds in the blood and bile of rats after oral administrations of extracts of sansohnin [symbol: see text]

We made a trial of searching for the bioactive substances from Sansohnin [symbol: see text]. The blood and bile of rats after the oral administration of extracts of Sansohnin were analyzed by three-dimensional high-performance liquid chromatography (3D-HPLC). In blood, spinosin and feruloyl spinosin were found after the oral administration of a butanol extract of Sansohnin. In bile, spinosin and feruloyl spinosin were also identified after the oral administration of a water extract of Sansohnin. Spinosin and feruloyl spinosin induced the prolongation of hexobarbital sleeping time in mice at doses of 50 and 100 mg/kg, respectively. We concluded that spinosin and feruloyl spinosin were the bioactive constituents of Sansohnin. It was assumed that spinosin and feruloyl spinosin circulated through the intestine and liver, therefore, these results will provide support for the sedative and hypnotic use of this crude drug in Oriental medicine.

Development of cellulose derivatives as novel enteric coating agents soluble at pH 3.5-4.5 and higher

Hydroxypropyl methylcellulose (HPMC) was selected as a base polymer to develop novel enteric coating agents for acid protection which can dissolve at pH around 4, and was modified with trimellitic acid or maleic acid at various degrees of substitution. These carboxylic acids have higher dissociation constants and higher solubility in water than the carboxylic acids of existing enteric coating polymers. The synthesized polymers were micronized and dispersed in aqueous medium to determine their pKa values by potentiometric titration. The pH of dissolution and the water vapor permeability of the cast films prepared from organic solutions were also evaluated. Hydroxypropyl methylcellulose trimellitate (HPMCT) showed good acid resistance, and the pH at which it dissolves can be controlled in the range of pH 3.5 to 4.5 by varying the content of trimellityl groups and the methoxyl substitution of the base polymer.

A repeated-dose dermal toxicity study of hydrophobically modified hydroxypropyl methylcellulose in rats

A six-month repeated-dose dermal toxicity study followed by a 30-day recovery test of hydrophobically modified hydroxypropyl methylcellulose (HM-HPMC), a new cellulose derivative used as a thickener for topical pharmaceuticals, was conducted using rats. Aqueous paste of HM-HPMC was applied to the skin of rats once daily at dose levels up to 60 mg/kg/day, which was the highest dose that could be administered. Items checked included general signs, urinalysis, hematology, ophthalmology, and histopathology. One rat died during the administration period owing to a malignant tumor in the hemopoietic system, which was not attributed to the test substance. Statistically significant differences were found in some test results, but those were not dose-dependent and were considered to be incidental or spontaneous. It was concluded that the test substance was not toxic upon chronic dermal administration at dose levels up to 60 mg/kg/day.

Full-thickness skin grafting of postsurgical oral defects: short- and long-term outcomes

PURPOSE

This study evaluated the use of full-thickness skin grafts (FTSGs) following excision of precancerous and cancerous oral lesions.

MATERIALS AND METHODS

Fourteen oral lesions, including five leukoplakias, one carcinoma in situ, two verrucous carcinomas, and six squamous cell carcinomas with varying grade of keratinization and invasion were skin grafted after excision. The size of the graft ranged from 16 x 22 mm to 40 x 50 mm, and the fixation period was 8 to 13 days. The grafts were evaluated for necrosis as a short-term result and shrinkage and recurrence of the lesion as long-term results.

RESULTS

Three cases with more than moderate necrosis of the grafted skin were observed (21.4%). Shrinkage was observed in 23% of the 14 skin grafts and tumor recurrence was observed in three FTSGs (2 patients).

CONCLUSIONS

The results suggest that the paucity of the blood supply in the grafted bed, and the uneven pressure and immobilization of the grafted skin, influence the success of the procedure, and that proper case selection is necessary.

Thermal responses to swimming in three water temperatures: influence of a wet suit

The primary objective of this investigation was to determine the thermal and metabolic effects of wearing a rubberized wet suit (WS) while swimming for 30 min in 20.1, 22.7, and 25.6 degrees C water. Metabolic and body temperature measurements were recorded in each water temperature with subjects wearing either a WS or a competitive swimming suit (SS). Immediately after each swim the subjects cycled for 15 min on a stationary cycle ergometer. Energy expenditure (VO2), heart rate, post-swim blood lactate, work completed on the cycle ergometer, and rating of perceived exertion (RPE) were similar in all trials. Mean (+/- SE) core temperature (Tc) during swimming in the SS trials increased 0.56 (+/- 0.33), 0.48 (+/- 0.20), and 1.22 (+/- 0.24) degrees C, whereas in the WS trial Tc rose 0.62 (+/- 0.22), 1.02 (+/- 0.15), and 0.89 (+/- 0.13) degrees C in the 20.1, 22.7, and 25.6 degrees C treatments, respectively. Following swimming many of the subjects experienced a decrease in Tc, but it was significantly elevated above preimmersion by the end of cycling in all trials except the SS 20.1 degrees C trial. Mean trunk temperatures (Ttr) during swimming in the WS trials were 4.32 +/- 0.16 (20.1 degrees C), 3.90 +/- 0.25 (22.7 degrees C), and 3.21 +/- 0.20 (25.6 degrees C) degrees C warmer than in the SS. Ttr rose after the subjects exited the water, but remained significantly below baseline throughout cycling in all trials.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparison of three methods used for treatment of ranula

PURPOSE

This report compares the treatment results for oral and plunging ranulas.

PATIENTS AND METHODS

Twenty-seven patients were retrospectively examined concerning treatment methods and recurrence on the basis of their medical records. The surgical specimens were also examined microscopically.

RESULTS

Four patients had excision of the ranula only, 22 had marsupialization, and nine had removal of the sublingual gland combined with the excision of the ranula. These treatments showed a 25.0%, 36.4% and 0% recurrence rate, respectively. Histological observation revealed no epithelial lining in any of the examined specimens.

CONCLUSIONS

Removal of the sublingual gland combined with the ranula was the most reliable method among the above three used.

Properties of free films prepared from aqueous polymers by a spraying technique

A spray method for the preparation of free films from aqueous polymeric dispersions was investigated. Free films were prepared from aqueous dispersions of methacrylic acid-ethyl methacrylate copolymer (Eudragit L 30D), hydroxypropyl methylcellulose acetate succinate (HPMCAS), cellulose acetate phthalate (CAP), and ethyl cellulose (EC) by a spray method and a cast method, and their mechanical properties and reproducibility were investigated. Uniform films were obtained from the dispersions of Eudragit L 30D, HPMCAS, and EC by the spray method, but films could not be formed by spraying the CAP dispersion. The tensile strength, elongation, and elastic modulus of the sprayed Eudragit L 30D films were similar to the properties of the cast films, and good reproducibility was obtained from both methods. Marked within-run variation in the mechanical properties was observed for the cast HPMCAS and CAP films, which could be due to a settling of the solid particles during the drying step. The variation in the mechanical properties of the sprayed HPMCAS films was lower and the tensile strength significantly higher than that of the cast films. There were also significant differences in tensile strength and elongation of EC films between products of the two methods. The results indicated that the spray method used to prepare the free films from aqueous polymeric dispersions provided uniform films with consistent and reproducible properties.

Chloride current observed as calcium-gated tail current in trigeminal root ganglion neurons of the marine catfish, Plotosus

Isolated trigeminal ganglion (TRG) neurons of Plotosus in primary culture were studied with patch electrodes in a whole-cell recording configuration. When Ca currents were isolated using electrodes filled with CsCl and Ca buffer in Na- and K-free saline, a large tail current was induced. Both Ca and tail currents were blocked by 2 mM Co2+ in the bath. Reversal potential of the tail current was close to the equilibrium potential for Cl-. The reversal potential was altered by substitution of external Cl- with Br- or methanesulphonate- (MSA-). The anion permeability ratios were estimated as PBr/PCl = 1.95 and PMSA/PCl < 0.05. These results suggested that the tail current was the Ca-gated Cl current. In Plotosus neurons, two types of Ca current, high- and low-voltage activated (HVA and LVA), have been described. Both types of Ca currents were able to induce a tail current. Ba currents through both HVA and LVA channels proved to be ineffective. Upon repetitive activation, the tail current progressively increased in the presence of a nearly constant peak Ca current, and showed a more prolonged complex decay phase. When the electrode was filled with 20 mM EGTA, no tail current was induced, not even after repetitive stimulation. Therefore, the tail current seemed to be regulated by local Ca activity in the vicinity of the membrane. The Ca-gated Cl tail current may regulate the membrane excitability of TRG neurons during repetitive firing.

Superoxide anion generation from peripheral blood neutrophils stimulated by N-formyl-methionyl-leucyl-phenylalanine in oromaxillary cancer patients

Superoxide anion (O2-) generation levels in peripheral blood neutrophils stimulated by N-formyl-methionyl-leucyl-phenylalanine were evaluated in patients with oromaxillary cancer. The levels in patients with benign tumors were nearly equal to those of normal controls. Patients with squamous cell carcinoma in stage I and II had levels that were widely distributed. On the other hand, O2- generation levels in the advanced stages (III and IV) of squamous cell carcinoma showed lower levels than those of controls (P < .01). All cases of oromaxillary carcinoma showed low levels of O2- generation within 1 month before death compared with controls (P < .01). The generation levels of O2- in the posttreatment period were lower than those before combination cancer treatments. Among cancer treatments such as chemotherapy, surgery, and irradiation, the latter had the strongest effects on O2- generation. These results suggest that low levels of O2- generation by peripheral blood neutrophils may reflect a worsening status of oromaxillary cancer patients.

Changes in cardiac rhythm in man during underwater submersion and swimming studied by ECG telemetry

A previously reported method for electrocardiographic (ECG) telemetry in water using frequency-modulated current was improved to obtain more stable ECGs. The ECGs of seven healthy men were monitored using the improved method during and after whole-body submersion or underwater swimming. Bradycardia and arrhythmias were observed during the submersion, and transient tachycardia was detected after the start of underwater swimming, followed by bradycardia with arrhythmias. Three different types of arrhythmias were observed: sinus arrhythmia (SA), supraventricular extrasystole (SE) and ventricular extrasystole (VE). SA and SE tended to develop during the latter half of the period of submersion or underwater swimming, and especially after the restart of breathing. VEs were detected in only one subject during submersion, whereas they occurred in most subjects during and after underwater swimming. Individual variations were found in development of arrhythmias, one subject showing no arrhythmia. Bradycardia, SA and SE could depend on vagal suppression in underwater conditions, and VE may be related to the effect of muscular movement on cardiac function in addition to vagal inhibition.

The membrane properties and Ca-currents of the trigeminal root ganglion cells in primary culture of the marine catfish, Plotosus, studied with whole-cell recordings

Neurons of the trigeminal root ganglion (TRG) were isolated from the marine catfish Plotosus. Collagenase treatment and culture in L15 medium, modified for higher tonicity, were required to remove their myelin sheath. TRG neurons were spherical 15-20 microns in diameter after 1-4 days culture, although they later developed extensive neurites. The membrane properties were studied by whole-cell recording technique. The resting potential was about -63 mV. The specific membrane resistance and capacitance, 5.9 K omega.cm2 and 1.2 microF/cm2, were similar to those of mouse dorsal root ganglion (DRG). The action potential, however, was usually humped, and followed by a long afterhyperpolarization. The maximum firing rate reached only about 70 Hz. Voltage-clamp study revealed TTX-sensitive Na current and TEA-sensitive K current, and in addition, two types of Ca currents: low- and high-voltage activated (LVA and HVA). The HVA current seemed to be involved in hump formation. The LVA current was similar in kinetics to T-type current of chick DRG, and was presumably inactivated at the resting potential, which might be removed during the afterhyperpolarization.

Induction of propranolol metabolism by the azo dye sudan III in rats

Effects of the azo dye sudan III, an inducer of cytochrome P450 isozymes belonging to the CYP1A subfamily, on propranolol (PL) in vitro and in vivo metabolism were investigated in rats. The kinetic parameters of the activity for each metabolic pathway were determined in liver microsomes from control and sudan III-treated rats. Sudan III pretreatment increased extensively PL 4-hydroxylase, 5-hydroxylase and N-desisopropylase activities at high but not at low PL concentrations. On the other hand, kinetic parameters of 7-hydroxylase activity were not affected by sudan III pretreatment. Sudan III pretreatment decreased blood concentrations of PL after intraportal infusion of PL at high doses (12.5 and 20 mg/kg), but not at a low dose (5 mg/kg). These observations were consistent with data obtained from the in intro studies showing that sudan III pretreatment induced low-affinity but not high-affinity cytochrome P450 isozymes involved in PL metabolism in rat liver microsomes.

Primary dermal and eye irritability tests of hydrophobically modified hydroxypropyl methylcellulose in rabbits

Primary dermal and eye irritation tests of hydrophobically modified hydroxypropyl methylcellulose (HM-HPMC, hydroxypropyl methylcellulose modified with stearylglycidylether), a new cellulose derivative used as a thickener for topical pharmaceuticals and cosmetics, were conducted in rabbits. A dispersion of HM-HPMC (3%) was applied to intact and abraded skins and reactions were observed. A very slight erythema was observed in both skins and this polymer was categorized as a "mild irritant". In the eye irritation test, with a dispersion of the same concentration, it was categorized as "marginal" in unrinsed eyes and "negative" in rinsed eyes.