Nephrotic syndrome induced by aortic regurgitation with Takayasu arteritis: an autopsy case with long-term clinical follow-up

Takayasu arteritis is a rare, chronic, and large-vessel vasculitis involving the aorta and its branches in a complex autoimmune reaction. Takayasu arteritis sometimes complicates aortic regurgitation and chronic kidney disease, but rarely accompanies nephrotic syndrome. We had a patient with Takayasu arteritis and concomitant aortic regurgitation. She had nephrotic syndrome that was refractory to immunosuppressive therapy but was promptly improved after surgical aortic valve replacement. In her kidney biopsy, glomeruli had mild mesangial proliferative changes without immune complex deposition. Her proteinuria remained negative until the recurrence of aortic regurgitation due to perivalvular leakage. Seventeen years after the surgery, she died suddenly. In her kidney autopsy, the arteriolar showed severe hyalinosis and the glomerulus showed mesangial proliferative changes with segmental mesangiolysis. Severe aortic regurgitation may have altered renal hemodynamics and caused glomerular lesions, resulting in nephrotic syndrome. We should be aware of the rare but critical comorbidity of nephrotic syndrome in patients with Takayasu arteritis and concomitant aortic regurgitation.

Malignant Hypertension and Bilateral Primary Aldosteronism

Malignant hypertension triggers incremental renin activity, whereas primary aldosteronism suppresses such activity. We encountered a patient with malignant hypertension refractory to multiple anti-hypertensive agents. Repeated neurohormonal assessments, instead of a single one, eventually uncovered trends in an incremental aldosterone concentration, ranging from 221 up to 468 pg/mL, with a decline in the renin activity from 2.3 to <0.2 ng/mL/h. Adrenal venous sampling confirmed bilateral aldosterone secretion. Following the diagnosis of bilateral primary aldosteronism, we initiated a mineralocorticoid receptor antagonist, which improved his blood pressure. Repeated neurohormonal assessments are encouraged to correctly diagnose underlying primary aldosteronism with malignant hypertension.

Tumor-to-tumor metastasis of diffuse large B cell lymphoma to gastric adenocarcinoma via CXCL12 (SDF-1)/CXCR4 axis: a case report

BACKGROUND

Tumor-to-tumor metastasis is the rare phenomenon in which one tumor exhibits metastatic deposits from another. To the best of our knowledge, there has been no prior reported case of tumor-to-tumor metastasis of a diffuse large B cell lymphoma (DLBCL) to a primary gastric adenocarcinoma.

CASE PRESENTATION

A 70-year-old man presented with chest discomfort. An echocardiogram showed the presence of a right ventricular tumor. A positron emission tomogram showed multiple foci of abnormal activity in right cervical lymph nodes, cardiac wall, and stomach. A right cervical lymph node biopsy specimen revealed histological features of DLBCL. An esophagogastroduodenoscopy showed a large circumferential ulceration on the gastric body. Subsequent biopsy revealed adenocarcinoma cells surrounded by infiltrating lymphoma cells. On immunohistochemical staining, lymphoma cells were positive for CXCR4 and adenocarcinoma cells were positive for CXCL12/SDF-1. The patient was treated with six cycles of R-CHOP chemotherapy regimen, resulting in a complete remission.

CONCLUSIONS

This patient's case implies that the interaction between a chemokine and its receptor may be the underlying mechanism for the observed tumor-to-tumor metastasis. Specifically, our case would suggest an involvement of the CXCL12 (SDF-1)/CXCR4 axis in the observed metastasis of DLBCL to primary gastric adenocarcinoma.

Cholesterol embolization syndrome and intra-abdominal bleeding immediately after initiation of hemodialysis: a case report with literature review

Background

Cholesterol embolization syndrome (CES) is a disease associating with the systemic cholesterol crystal embolism and end-organ dysfunction due to the atherosclerotic plaque rupture, which is dominantly triggered by the intravascular intervention. There is no consensus for which types of anticoagulants we should use during the hemodialysis in patients with CES and end-stage renal disease.

Case presentation

We had a 68-year-old man with CES due to intravascular intervention, who suffered the omental bleeding, instead of the embolism, immediately after the initiation of hemodialysis with heparinization. An emergent laparotomy found active bleeding from the omentum, which was surgically repaired. The histopathological analysis showed the embolization of cholesterol crystal clefts in the omentum artery and the injury of arterial wall structure accompanied by the infiltration of inflammatory cells. We preferred nafamostat mesylate during hemodialysis and he had no adverse events following the surgery.

Conclusions

It should be noticed that, in addition to the embolic events, bleeding events can develop in patients with CES, particularly following the initiation of hemodialysis with anticoagulation therapy.

Nephrotic Syndrome with Focal Segmental Glomerulosclerosis Induced by Intravitreal Injections of Vascular Endothelial Growth Factor Inhibitor

An 83-year-old woman with a 1-year history of scheduled intravitreal injection of vascular endothelial growth factor (VEGF) inhibitor (aflibercept) was diagnosed with nephrotic syndrome due to focal segmental glomerulosclerosis with histopathological findings of segmental infiltration of foam cells in the glomerular capillaries. Her nephrotic syndrome improved immediately following the termination of aflibercept intravitreal injection without steroid therapy. Although widely used to treat ophthalmic diseases, we should keep in mind that even intravitreal injection of VEGF inhibitor, as opposed to systemic administration, can cause kidney injury.

Detailed Arterial Anatomy and Its Anastomoses of the Sphenoid Ridge and Olfactory Groove Meningiomas with Special Reference to the Recurrent Branches from the Ophthalmic Artery

BACKGROUND AND PURPOSE

Detailed arterial anatomy of the sphenoid ridge and olfactory groove meningiomas is complicated due to the fine angioarchitecture and anastomoses between each feeder. Herein, we present details of the arterial anatomy and the relationships of feeders in these lesions.

MATERIALS AND METHODS

This study included 20 patients admitted to our department between April 2015 and March 2020. Conditions of subjects consisted of 16 sphenoid ridge meningiomas and 4 olfactory groove meningiomas. We mainly analyzed arterial anatomy using 3D rotational angiography and slab MIP images of these lesions. We also analyzed the anastomoses of each feeder.

RESULTS

We found that 19 (95%), 15 (75%), and 15 (75%) lesions had feeders from the ophthalmic, internal carotid, and external carotid arteries, respectively. As feeders from the ophthalmic artery, recurrent meningeal arteries were involved in 18 lesions (90%). Fifteen lesions (75%) had anastomoses between each feeder.

CONCLUSIONS

Most of the meningiomas in the sphenoid ridge and olfactory groove had feeders from the ophthalmic and internal carotid arteries. There were various anastomoses between each feeder. This is the first report to demonstrate the detailed arterial anatomy and frequency of recurrent branches from the ophthalmic artery and their anastomoses using detailed imaging techniques.

Arterial stiffness could reflect increased cardiac load and reduced pulmonary function in the general population

Background

Pulmonary function is known to decrease with age and reduced pulmonary function has been reported to be associated with all-cause mortality and cardiovascular death. The association between pulmonary impairment and atherosclerosis was reported previously but has not been investigated sufficiently in the general population.

Purpose

We hypothesized that arterial stiffness could reflect increase of cardiac load and reduced pulmonary function. The present study aimed to investigate whether increased cardiac load and reduced pulmonary function could affect arterial stiffness in the general population.

Methods

Subjects undergoing their health check-up were enrolled. Plasma B-type natriuretic peptide (BNP) levels and serum high-sensitivity cardiac troponin I (hs-cTnI) levels were measured to evaluate cardiac load and myocardial damage. Radial augmentation index (rAI) was measured to investigate arterial stiffness using HEM-9000AI device. Subjects with an ST-T segment abnormality on the electrocardiogram, renal insufficiency, cancer, active inflammatory disease, or a history of cardiovascular events and pulmonary disease were excluded. Pulmonary function was assessed using spirometry by calculating forced vital capacity (FVC) as a percentage of predicted value (FVC%-predicted), forced expiratory volume in 1 second (FEV1) as a percentage of predicted value (FEV1%-predicted), and the ratio of FEV1 to FVC (FEV1/FVC).

Results

A total of 1100 subjects aged 57 years were enrolled and their median values of BNP and hs-cTnI were 15.5 and 2.3 pg/ml. The levels of rAI were significantly associated with the levels of BNP after adjustment for possible confounders in multivariate regression analysis, but were not with the levels of hs-TnI. While the parameters of pulmonary function were inversely associated with the levels of rAI and hs-cTnI after adjustment for possible confounders in the multivariate regression analysis, but not with the levels of BNP. The other multivariate regression analyses where BNP, hs-cTnI, parameters of pulmonary function, and the other possible factors were simultaneously included as independent variables revealed that the BNP levels and the FVC%-predicted or FEV1%-predicted, besides age, gender, smoking status, body mass index, blood pressure, heart rate, creatinine, fasting plasma glucose, and triglyceride, were significantly associated with the levels of rAI.

Conclusions

The significant associations of rAI with BNP and pulmonary function were revealed in the general population. These findings support that arterial stiffness could reflect increased cardiac load and reduced pulmonary function, in apparently healthy individuals.

Funding Acknowledgement

Type of funding source: None

Outcome of maintenance systemic chemotherapy with drug-free interval for metastatic urothelial carcinoma

OBJECTIVE

Aiming to achieve long-term disease control, maintenance systemic chemotherapy (MSC) with a 1-3-month drug-free interval is continued in selected patients. We report our experience of MSC for metastatic urothelial carcinoma (UC).

METHODS

Of 228 metastatic UC patients treated with systemic chemotherapy, 40 (17.5%, 40/228) had continuously undergone MSC. Data on the regimen, cycle number, and reason for the discontinuation of MSC were also collected. We analyzed OS from the initiation of MSC until death or the last follow-up, using the log-rank test to assess the significance of differences.

RESULTS

The median number of cycles of chemotherapy was 6, and the responses were CR in 6, PR in 20, SD in 13, and PD in 1 before MSC. Gemcitabine plus CDDP or carboplatin was mainly performed as MSC (70%, 28/40). MSC was repeated quarterly in 30 (75%, 30/40), every two months in 8 (20%, 8/40), and with other intervals in 2 (5%, 2/40). Overall, a median of 3.5 cycles (range: 1-29) of MSC was performed. The reason for the discontinuation of MSC was PD in 24 (60%, 24/40), favorable disease control in 9 (22.5%, 9/40), and myelosuppression in 3 (7.5%, 3/40), and for other reasons in 2 (5%, 2/40). MSC was ongoing in 2 (5%, 2/40). The median OS was 27 months from the initiation of MSC. PS0 (P = 0.0169), the absence of lung metastasis (P = 0.0387), and resection of the primary site (P = 0.0495) were associated with long-term survival after MSC.

CONCLUSIONS

In selected patients, long-term systemic chemotherapy could be performed with a drug-free interval. Our maintenance strategy with cytotoxic drugs may become one of the treatment options for long-term disease control.

[A case of oldest-old patient with chronic renal failure successfully treated with peritoneal dialysis]

He was a 92-year-old male patient with mild cognitive impairment while preserved activity of daily life. His renal dysfunction gradually increased due to the nephrosclerosis accompanied by systemic edema and water retention. We eventually decided to initiate peritoneal dialysis instead of standard hemodialysis for his end-stage renal dysfunction refractory to optimal medical therapy, given his preserved cognitive function and family support. He underwent an established therapeutic program for the peritoneal dialysis at home with an Information and Communication Technology (ICT).Given the increase in age of the patients with renal dysfunction, peritoneal dialysis has been receiving great attention as a home care strategy. The recent improvement in the device technology and ICT that enables us remote monitoring would reduce patients' effort in the management of peritoneal dialysis. Collaboration with home nursing and care workers would also be warranted for successful home care.

Inhibition of malic enzyme 1 disrupts cellular metabolism and leads to vulnerability in cancer cells in glucose-restricted conditions

Malic enzyme 1 (ME1) regulates one of the main pathways that provide nicotinamide adenine dinucleotide phosphate (NADPH), which is essential for cancer cell growth through maintenance of redox balance and biosynthesis processes in the cytoplasm. In this study, we found that ME1 inhibition disrupted metabolism in cancer cells and inhibited cancer cell growth by inducing senescence or apoptosis. In glucose-restricted culture conditions, cancer cells increased ME1 expression, and tracer experiments with labelled glutamine revealed that the flux of ME1-derived pyruvate to citrate was enhanced. In addition, cancer cells showed higher sensitivity to ME1 depletion in glucose-restricted conditions compared to normal culture conditions. These results suggest that in a low-glucose environment, where glycolysis and the pentose phosphate pathway (PPP) is attenuated, cancer cells become dependent on ME1 for the supply of NADPH and pyruvate. Our data demonstrate that ME1 is a promising target for cancer treatment, and a strategy using ME1 inhibitors combined with inhibition of glycolysis, PPP or redox balance regulators may provide an effective therapeutic option.

Application of strain to orbital-spin-coupled system MnV2O4 at cryogenic temperatures within a transmission electron microscope

The impact of mechanical stress on the morphology of crystallographic and magnetic domains in shape-controlled specimens of an orbital-spin-coupled system, MnV2O4, was examined by cryogenic Lorentz microscopy. Because of the difference in thermal expansion coefficients of MnV2O4 and the supporting Mo mesh, compression on the order of 0.01% was applied to the thin-foil specimens near the structural/magnetic phase transformation temperatures. The extent of compression was comparable to the lattice striction associated with the cubic-to-tetragonal phase transformation in MnV2O4 The applied strain thus clearly influenced the morphology of crystallographic domains (i.e. twinning configuration in the tetragonal phase) produced during cooling. The magnetic domain structure was entirely dependent on the configuration of twinning in the tetragonal phase. The observations in this study provided useful information for understanding the relationship between the crystallographic domains and the magnetic domains in MnV2O4.

A field survey of the partially edentate elderly: Investigation of factors related to the usage rate of removable partial dentures

Although the shortened dental arch (SDA) concept has been known to all over the world, acceptance of the SDA concept as an oral health standard can be questionable from the patients' point of view, even if it is biologically reasonable. Furthermore, because the health insurance system covers removable partial dentures (RPDs) for all citizens in Japan, SDA patients seem to prefer to receive prosthetic treatment to replace the missing teeth. However, there were few field surveys to investigate the usage rate of RPDs in Japan. The purpose of this study was to determine the usage rate of RPDs in older Japanese subjects and to investigate the factors related to the usage of RPDs. Partially edentate participants (n = 390) were included in this study. Oral examinations were conducted to record several indices. The Cochran-Armitage trend test was used to evaluate the relationship between the number of missing teeth and the usage rate of RPDs. Chi-squared tests and logistic regression analysis were conducted to evaluate the factors related to the usage rate of RPDs. Usage of RPDs had a significantly positive association with the number of missing distal extension teeth and bilaterally missing teeth. The usage rate of RPDs increased as the number of missing distal extension teeth increased (P for trend < 0·001). The conclusion of this study was that participants with missing distal extension teeth had higher usage rates of RPDs than other participants, and the usage rate increased as the number of missing distal extension teeth increased.

Hybrid plasmonic-photonic modes in diffractive arrays of nanoparticles coupled to light-emitting optical waveguides

We study the hybridized plasmonic-photonic modes supported by two-dimensional arrays of metallic nanoparticles coupled to light-emitting optical waveguides. Localized surface plasmon polaritons in the metallic nanoparticles can couple to guided modes in the underlying waveguide, forming quasi-guided hybrid modes, or to diffracted orders in the plane of the array, forming surface lattice resonances. We consider three kinds of samples: one sustains quasi-guided modes only, another sustains surface lattice resonances only, and a third sample sustains both modes. This third sample constitutes the first demonstration of simultaneous coupling of localized surface plasmons to guided modes and diffracted orders. The dispersive properties of the modes in the samples are investigated through light extinction and emission spectroscopy. We elucidate the conditions that lead to the coexistence of surface lattice resonances and quasi-guided hybrid modes, and assess their potential for enhancing the luminescence of emitters embedded in the coupled waveguide. We find the largest increase in emission intensity for the surface lattice resonances, reaching up to a factor of 20.

Light-emitting waveguide-plasmon polaritons

We demonstrate the generation of light in an optical waveguide strongly coupled to a periodic array of metallic nanoantennas. This coupling gives rise to hybrid waveguide-plasmon polaritons (WPPs), which undergo a transmutation from plasmon to waveguide mode and vice versa as the eigenfrequency detuning of the bare states transits through zero. Near zero detuning, the structure is nearly transparent in the far-field but sustains strong local field enhancements inside the waveguide. Consequently, light-emitting WPPs are strongly enhanced at energies and in-plane momenta for which WPPs minimize light extinction. We elucidate the unusual properties of these polaritons through a classical model of coupled harmonic oscillators.

Reproducibility of 24-hour dietary recall for vitamin intakes by middle-aged Japanese men and women

OBJECTIVE

To examine the reproducibility of 24-hour dietary recall for estimating dietary vitamin intakes by middle-aged Japanese men and women.

METHODS AND RESULTS

The subjects were 132 men and 130 women aged 40-69 years, selected from participants in cardiovascular risk surveys conducted in 4 communities. The reproducibility of the 24-hour dietary recall was tested by comparing nutrient and food intake for two recalls conducted on the same season 1 year apart, designated as recalls 1 and 2. Differences in mean values between two recalls were tested using analysis of variance, and Spearman rank correlation coefficients for the two recalls were calculated for nutrient and food intakes. Mean values of energy and vitamins for both sexes were generally similar for the two recalls. The reproducibility of recall by men was high for vitamin B2, folate, pantothenic acid, and vitamin C and by women for vitamin B2, moderate by men for vitamins A, E, K, B1, B6 and niacin, and by women for vitamins A, E, K, B1, B6 and niacin, folate, pantothenic acid and vitamin C, and low by both men and women for vitamins D and B12. The reproducibility during 1985-1999 was generally lower than that of 1973-1984, but that for folate, pantothenic acid and vitamin C remained to be moderate in 1984-1999.

CONCLUSIONS

Although the reproducibility of 24-hour dietary recall varies among vitamins, moderate and sustained reproducibility was observed for folate, vitamin C and pantothenic acid.

Pulmonary alveolar microlithiasis: CT and pathologic findings in 10 patients

BACKGROUND AND AIM

To evaluate CT findings of pulmonary alveolar microlithiasis and correlate the CT with the pathologic findings.

METHODS

The study included 10 patients with pathologically proven microlithiasis. Two independent observers evaluated the presence, extent and distribution of the CT findings. CT findings were compared with those at autopsy in two patients and with transbronchial biopsy in eight patients.

RESULTS

All patients had a myriad of calcified nodules measuring approximately 1 mm in diameter. Close apposition of the nodules resulted in areas of ground-glass attenuation and consolidation, which were the predominant abnormality on CT in all 10 patients, involving 41% +/- 16.3 (mean +/- SD) and 30% +/- 4.8 of the lung parenchyma, respectively. Calcifications were also seen along interlobular septa, bronchovascular bundles and pleura. Other findings included interlobular septal thickening, thickening of bronchovascular bundles, nodules, and subpleural cysts. There was a solid agreement between the observers for the presence (kappa value; 0.77) and extent (Spearman rank correlation; r = 0.81 to 1.0 p < 0.01) of abnormalities. Autopsy specimens demonstrated microliths in alveolar airspaces and along interlobular septa, bronchovascular bundles and pleura. Subpleural small cysts were shown to represent dilated alveolar ducts.

CONCLUSION

Pulmonary microlithiasis is characterised by the presence of numerous small, calcified nodules, calcifications along interlobular septa, bronchovascular bundles and pleura, ground-glass opacities, consolidation, and subpleural cysts. The cysts represent dilated alveolar ducts.

Cerebral cortex activity during supramaximal exhaustive exercise

AIM

The purpose of this study was to examine the effect of fatigue resulting from supramaximal dynamic exercise on cerebral cortex activity.

METHODS

Five healthy male subjects (age 24.6+/-0.4 years, body weight 62.9+/-1.1 kg, height 175.3+/-1.2 cm, and maximal O2 uptake per body mass 48.4+/-1.3 ml/kg/min) participated in this study. All subjects performed at 120% of maximal oxygen uptake (VO2peak) on a cycle ergometer until reaching a state of volitional fatigue. Cerebral oxygenation was measured by near-infrared spectroscopy (NIRS) throughout the supramaximal constant exhaustive exercise.

RESULTS

The mean exercise duration of the subjects was 147.2+/-3.4 s. The peak value of blood lactate concentration within 3-10 min after the exercise test was 14.4+/-0.1 mmol/l. Cerebral oxygenation (8.8+/-1.8 micromol/l) was increased significantly during the first minutes of exercise compared with the pre-exercise value (p<0.05) and cerebral oxygenation decreased with the passage of time during exercise. Cerebral oxygenation at the end of exercise decreased significantly compared with the resting value (-29.9+/-3.4 micromol/l, p<0.05).

CONCLUSION

These findings suggest that the exhaustive exercise induces the decrease of cerebral function and that the fatigue resulting from dynamic exercise decreases the cerebral cortex activity.

Dual adrenergic control of in vivo choline levels in the mouse major salivary glands

1. The purpose of this study was to demonstrate that the adrenergic nervous system regulates the in vivo choline levels in the mouse major salivary glands. 2. Methoxamine (alpha1-adrenoceptor agonist, 2.5-20 mg kg-1, s.c.) elevated choline levels dose-dependently and the effect of methoxamine (10 mg kg-1) was completely inhibited by the alpha-adrenoceptor antagonist phentolamine (5 mg kg-1, i.p.) but not by the beta-adrenoceptor antagonist propranolol (3 mg kg-1, i.p.). 3. In contrast, isoprenaline (beta-adrenoceptor agonist 0.25-20 mg kg-1, s.c.) lowered choline levels and the effect of isoprenaline (2 mg kg-1) was inhibited by propranolol, but not by phentolamine. 4 Noradrenaline (1-4 mg kg-1, s.c.) manifested both the alpha- and beta-adrenergic actions depending on its dose. Noradrenaline at 1-2 mg kg-1, lowered choline levels and the effect of noradrenaline (1 mg kg-1) was inhibited by propranolol, but not by phentolamine. On the other hand, noradrenaline (4 mg kg-1) elevated choline levels and the effect was blocked by phentolamine, but not by propranolol. 5. Tyramine (5-80 mg kg-1, s.c.) elicited the release of noradrenaline from sympathetic nerve terminals and induced essentially the same effects on the choline levels as noradrenaline. Tyramine (10 mg kg-1) lowered choline levels and the effect was inhibited by propranolol, but not by phentolamine. However, tyramine (80 mg kg-1) elevated choline levels and the effect was inhibited by phentolamine, but not by propranolol. 6. These results suggest that choline levels in the salivary glands may be under separate alpha- and beta-adrenergic control and suggest a possibility that the neurotransmitter noradrenaline released for sympathetic nerve terminals can manage the dual control of choline levels in some autonomic organs in a characteristic dose-dependent manner.

Acute coronary syndrome associated with oral administration of ritodrine hydrochloride during pregnancy: a case report

We report a case of acute coronary syndrome associated with the oral administration of ritodrine hydrochloride. Ten days following the administration of ritodrine hydrochloride, the patient complained of chest pain, and an electrocardiogram showed ST elevation and ST depression. Intensive care was initiated. She recovered without chest pain.

Tumoral calcinosis in both index fingers: a case report

Tumoral calcinosis is an uncommon disease of unknown aetiology that usually involves the periarticular tissues of large joints. We report a rare case in which it presented in both index fingers in a 5-year-old boy. The tumours were resected and he made an uncomplicated recovery except for mild tapering deformity on the left. There has been no sign of recurrence a year later.

Ru(3)(CO)(12)-catalyzed coupling reaction of sp(3) C-H bonds adjacent to a nitrogen atom in alkylamines with alkenes

Catalytic reactions which involve the cleavage of an sp(3) C-H bond adjacent to a nitrogen atom in N-2-pyridynyl alkylamines are described. The use of Ru(3)(CO)(12) as the catalyst results in the addition of the sp(3) C-H bond across the alkene bond to give the coupling products. A variety of alkenes, including terminal, internal, and cyclic alkenes, can be used for the coupling reaction. The presence of directing groups, such as pyridine, pyrimidine, and an oxazoline ring, on the nitrogen of the amine is critical for a successful reaction. This result indicates the importance of the coordination of the nitrogen atom to the ruthenium catalyst. In addition, the nature of the substituents on the pyridine ring has a significant effect on the efficiency of the reaction. Thus, the substitution of an electron-withdrawing group on the pyridine ring as well as a substitution adjacent to the sp(2) nitrogen in the pyridine ring dramatically retards the reaction. Cyclic amines are more reactive than acyclic ones. The choice of solvent is also very important. Of the solvents examined, 2-propanol is the solvent of choice.

Long-term histological prognosis and serum fibrosis markers in chronic hepatitis C patients treated with interferon

BACKGROUND

Interferon (IFN) therapy is effective in 20-40% of patients with chronic hepatitis C, but the relationship between histological changes and the response to interferon is still unclear. We investigated the long-term histological prognosis and the changes of serum fibrosis markers after interferon therapy relation to the response.

METHODS AND RESULTS

One hundred and eighteen patients with chronic hepatitis C who received interferon therapy were divided into four groups based on the detection of viremia and the serum alanine aminotransferase (ALT) level after treatment. A histological examination was performed by using the histological activity index and the criteria of the METAVIR score. Serum fibrosis markers were used to measure the levels of hyaluronic acid and type IV collagen 7s. Responders, whose serum ALT levels became normal after treatment, demonstrated histological improvement. Histological improvement was more rapid in sustained virological responders with hepatitis C virus (HCV) RNA seronegativity than in biochemical responders with HCV-RNA seropositivity. Only sustained virological responders exhibited histological cure. In partial responders, whose serum ALT levels decreased to less than twice the upper of normal, and non-responders whose serum ALT levels were not reduced, liver fibrosis was unchanged or showed progression. Serum fibrosis markers increased with progression of the histological stage and varied depending on the response to interferon.

CONCLUSION

Normalization of serum ALT levels after interferon therapy led to a histological improvement, and that with viral clearance achieved histological cure. Serum fibrosis markers were useful indicators for long-term according to the response of IFN therapy.

An improved method for assaying phosphocholine and glycerophosphocholine in mouse tissue

INTRODUCTION

To measure the levels of phosphocholine (PCh) and glycerophosphocholine (GPCh) in the tissues and organs of mice, we developed a simple and rapid method using high-performance liquid chromatography (HPLC) with electrochemical detection (ECD) and an immobilized enzyme column.

METHODS

Under our modifications of the separation procedure of Klein et al. [Neurochem. Int. 2 (1993) 293], PCh and GPCh in the hydrophilic phase of the homogenate samples were selectively hydrolyzed into free choline by alkaline phosphatase and a 0.4-N perchloric acid solution, respectively, and the resulting hydrolyzed mixtures were directly injected into the HPLC system for analysis.

RESULTS

The present method permits PCh or GPCh assay within 5 min in one chromatographic run. Recoveries from tissue samples were 97% for PCh and 101% for GPCh. The percentages of the crossover reaction to the authentic PCh and GPCh were 0.4% and 3.8%, respectively. The within-run coefficients of variation for choline derived from PCh and GPCh in the tissue samples were 1.2% and 1.4%, respectively.

DISCUSSION

The method is effective and has been applied to the measurement of PCh and GPCh levels in several tissues of mice.

Influence of TT virus infection on the thrombocytopenia of patients with chronic liver disease

TT virus (TTV) can replicate not only in the liver but also in hematopoietic cells. To investigate the possible influence of TTV infection on the hematological parameters of patients with chronic liver disease, serum samples from 581 patients with chronic, viral or non-viral liver disease were tested for TTV DNA by polymerase chain reaction (PCR). PCR was performed by two distinct methods using N22 primer pairs (N22 PCR), which detect primarily the four major TTV genotypes (1-4), and using genotype 1-specific primers (Genotype 1-PCR). Thirteen hematological parameters measured in routine laboratory tests were compared among the patients who were positive or negative for TTV infection. The platelet count was significantly lower in the N22 PCR-positive group than in the N22 PCR-negative group among the 189 patients with chronic hepatitis C (CH-C) and among the 40 patients with chronic hepatitis without serological markers of ongoing hepatitis B virus or hepatitis C virus infection (CH-NBNC) (P<0.0001, P<0.005, respectively). Similarly, among the patients with CH-C or CH-NBNC, the platelet count was significantly lower in the TTV genotype 1-positive group than in the TTV genotype 1-negative group (P<0.001, P<0.05, respectively). The reduced platelet count of the TTV DNA-positive group was observed in every fibrotic stage of chronic hepatitis (F0-F3). These results suggest that infection of TTV of certain genotypes including genotype 1 may worsen the thrombocytopenia of patients with CH-C or CH-NBNC, irrespective of the degree of hepatic fibrosis.

Influence of TT virus on the histopathological features of nonalcoholic fatty liver disease

The sera of 38 patients with nonalcoholic fatty liver disease (NAFLD) including nonalcoholic steatohepatitis (NASH), were tested for TT virus (TTV) DNA by polymerase chain reaction (PCR) using three different primer pairs (UTR PCR, N22 PCR and genotype-1 PCR), and various histological features of the liver biopsy specimens were compared among those who were positive or negative for TTV infection. By UTR PCR which detects all TTV genotypes, TTV DNA was detected in 37 (97%) of the 38 patients. In contrast, N22 PCR which detects primarily TTV genotypes 1-4, detected TTV DNA in 18 patients (47%). In the liver biopsy specimens, moderate to many acidophilic bodies, moderate to marked focal/spotty necrosis of hepatocytes and marked stellate, pericellular or perivenular fibrosis were observed significantly more frequently among those who were positive for TTV DNA by N22 PCR, than among those who were negative by N22 PCR. Twelve patients (32%) were positive for TTV genotype 1. Moderate to marked vacuolation of nuclei, moderate to many acidophilic bodies, and moderate to marked focal/spotty necrosis as well as marked stellate, pericellular or perivenular fibrosis were found significantly more frequently in the TTV genotype 1-positive group than in the TTV genotype 1-negative group. These results suggest that certain TTV genotypes including genotype 1 influence the necrosis and inflammation of hepatocytes and liver fibrosis in NAFLD patients.

Does the control of alanine aminotransferase levels lead to a regression of liver fibrosis in chronic hepatitis C patients?

The aim of this study was to investigate the effect of various medications other than interferon (IFN) on liver fibrosis in chronic hepatitis C (CH-C) patients, and the results were compared with those obtained in CH-C patients without therapy. Fifty CH-C patients (32 men and 18 women; mean age 58.5 years) without previous IFN therapy, who randomly received medicines other than IFN such as Stronger Neo-Minophagen C, Ursodeoxycholic acid and a herbal medicine, Sho-saiko-to (TJ-9) (Group I), and as a control group, 45 CH-C patients (27 men and 18 women; mean age 56.6 years) without therapy (Group II) were examined. All patients had persistent alanine aminotransferase (ALT) elevation more than 6 months before this study and were also subdivided into three subgroups according to different pattern of ALT during the observation period, i.e. (a): persistently ALT<60 IU/l (below about twice the upper limit of normal range); (b): persistently ALT>/=60 IU/l; and (c) other than (a) and (b). All patients were biopsied twice before starting this study and during observation period and the liver fibrosis was compared between them by staging in each case. When the fibrosis stage was the same between two specimens, we determined whether the degree of fibrosis had improved or worsened by computed image analysis. Blood tests for fibrosis marker, serum aminoterminal peptide of type III procollagen (P III P) and liver enzyme such as albumin (Alb) and zinc turbidity test (ZTT) levels, and platelet (Plt) counts were also examined on the two times of liver biopsy. As a result, there were no significant differences in fibrotic improvement rate when assessed by both staging only and staging together with fibrotic ratio, determined by computed image analysis and also in yearly change of P III P (P/Y) and fibrosis (F/Y), the changed rate of Alb, ZTT levels and Plt counts between Group I and Group II, except for P/Y in subgroup (a) which was rather higher in Group I than in Group II. There were also no significant relationship between the changes of histological activity and fibrosis staging in both groups. In conclusion, other medications than IFN could not significantly improve both liver fibrosis and its associated laboratory data irrespective of ALT levels in CH-C patients as compared to the control group during average 3 years' follow-up period.

Influence of TT virus on the clinical course of alcoholic liver disease

The sera of 43 patients with alcoholic liver disease (ALD) who abstained from alcohol for 4 weeks, were tested for TT virus (TTV) DNA by polymerase chain reaction (PCR) using three different primer pairs (UTR PCR, N22 PCR and genotype-1 PCR). The clinical course of the TTV DNA-positive and -negative groups was compared. By UTR PCR which detects all TTV genotypes, TTV DNA was detected in 40 patients (93%). N22 PCR which detects primarily TTV genotypes 1-6, detected TTV DNA in 17 patients (40%). The alanine aminotransferase (ALT) level 4 weeks after the start of abstinence was significantly higher and the rate of change in ALT {[(ALT on admission-ALT 4 weeks after abstinence)/(ALT on admission)]x100} was lower in the patients who were positive by N22 PCR, than in those who were negative by N22 PCR. Twelve patients (28%) were positive for TTV genotype 1. In the TTV genotype 1-positive group, the ALT 4 weeks after the start of abstinence was significantly higher, and the improvement rates of ALT, gamma-glutamyl transpeptidase and alkaline phosphatase levels were lower than those in the TTV genotype 1-negative group. These results suggest that certain genotypes of TTV may interfere with the improvement of liver function following the start of abstinence in ALD patients.

Ynolate chemistry. Reaction of a silylynolate with aziridines leading to gamma-lactams

A silylynolate, generated via the carbonylation of lithium silyldiazomethane, was reacted with N-tosyl aziridines to produce various five-membered lactams in good yields. The key step of this reaction involves the ring-opening ketenylation of aziridines by the silylynolate. The reaction proceeded in a highly stereoselective manner, and ketenylation took place at the less hindered carbon. When treated with aldehydes prior to protonation, the alpha-silylated lactam enolates gave alpha-vinylidene gamma-lactams. These reactions represent a unique path to the generation of and for controlling the reactivity of a rare class of reactive intermediates, namely, acyllithium derivatives and ynolates.

In vivo changes in free choline level induced by autonomic agonists in mouse organs, including three major salivary glands

Whether free choline levels are changeable in vivo in response to different types of autonomic agonists was examined in several mouse organs. Upon one subcutaneous injection of isoproterenol, phenylephrine and pilocarpine, choline levels in whole organ decreased, increased and decreased, respectively, in various organs within 30 min and returned to initial levels in a day. In the three major salivary glands, a delayed choline elevation also appeared on day 2 after one isoproterenol injection and subsided by day 6. Only in the three salivary glands more choline was accumulated after 10 once-a-day injections of isoproterenol than after one isoproterenol injection. Neither phenylephrine nor pilocarpine induced comparable choline accumulation in any organs examined. Isoproterenol injection repeated at a 2-day interval augmented the subsequent, delayed choline elevation. Examination with dobutamine and the adenylyl cyclase activator 6-(3-dimethylaminopropionyl)forskolin suggested that isoproterenol-induced immediate choline lowering was down-stream of cAMP synthesis and linked to cAMP more tightly than the choline accumulation, though both choline changes occurred via beta1-adrenergic receptors. Choline levels in the salivary glands also changed depending on the form of diet given and particularly in the parotid gland in parallel with gland weights. These results provide the first evidence for the autonomic control of intracellular choline levels; intracellular choline levels might be an integral part of the autonomic signalling pathway.

Detection of mitochondrial DNA mutations in human gingival tissues

The accumulation of mitochondrial DNA mutation is an important contributor to the aging process. Polymerase chain reaction (PCR) amplification was carried out on total DNA from gingival tissues of human subjects with ages of 19 to 64 years, and 5.0-kb and 7.4-kb deletions were found in the mitochondrial genomes of these subjects. This is the first report of mitochondrial DNA deletion detectable in human gingival tissues.

Involvement of hrs binding protein in IgE receptor-triggered exocytosis in RBL-2H3 mast cells

Hrs binding protein (Hbp) tightly associated with Hrs is thought to play a regulatory role in vesicular trafficking during endocytosis and exocytosis. In this study, we have expressed dominant-negative mutants of Hbp to evaluate their effects on the degranulation of secretory granules in RBL-2H3 mast cells. The dominant-negative mutants of Hbp significantly inhibited IgE receptor (FcepsilonRI)-triggered secretory response as tested by beta-hexosaminidase release. These results suggest that Hbp functions as a regulator in the FcepsilonRI-triggered degranulation of secretory granules in mast cells.

Analysis of aspartate aminotransferase in gingival crevicular fluid assessed by using PocketWatch: a longitudinal study with initial therapy

AIM

The aim of this longitudinal study was to analyze the level of aspartate aminotransferase (AST) in gingival crevicular fluid (GCF) by using PocketWatch before and after initial therapy in patients with chronic adult periodontitis and to determine the relationship between AST and conventional measures of periodontal status, such as probing depth, clinical attachment level, bleeding on probing, and gingival index.

METHOD

A total of 11 patients with chronic adult periodontitis were enrolled. Their periodontal status and AST levels in GCF were measured at baseline and post-initial therapy (the number of pockets=67), and statistically analyzed.

RESULTS

There was a statistically significant difference in AST levels between diseased periodontal sites (1.2+/-0.7) and healthy sites (0.3+/-0.6, p<0.05), and between baseline and post-initial therapy (p<0.05). Improvements in clinical status were noted following periodontal therapy and there was a corresponding decrease in AST levels.

CONCLUSIONS

In conclusion, it is suggested that AST levels may be a useful adjunct in the clinical assessment of periodontal disease sites, since AST level decreases when periodontal status improves.

A comparison of the bactericidal effects and cytotoxic activity of three types of oxidizing water, prepared by electrolysis, as chemical dental plaque control agents

Acid oxidizing water (AOW), neutral oxidizing water (NtOW) and acid oxidizing water with a low available chlorine concentration (AOW-LC) may be obtained by electrolyzing a solution of tap water containing various quantities of NaCl and HCl. This study compared the bactericidal effects of these waters on cariogenic and periodontopathogenic bacteria and their cytotoxicities against epithelial cells. AOW, NtOW and AOW-LC showed considerable bactericidal effects. The cytotoxicity of AOW-LC was significantly lower than the other solutions tested (P<0.0001). The results indicated that the three types of oxidizing water had similar activity in inhibiting bacterial plaque formation as conventional chemical plaque-control agents.

A preliminary comparative study of the guided tissue regeneration and free gingival graft procedures for adjacent facial root coverage

OBJECTIVE

The purpose of this study was to compare the clinical efficacy of guided tissue regeneration with expanded polytetrafluoroethylene membranes to that of free gingival graft for treatment of adjacent facial gingival recession.

METHOD AND MATERIALS

Eight adjacent gingival recession sites with Miller class I or II defects containing at least a maxillary or mandibular canine were selected in 6 patients. Four recession sites in 3 patients were treated with guided tissue regeneration, and the other 4 sites in the remaining 3 patients were treated with free gingival graft. Probing depth, gingival recession, attachment level, width of keratinized gingiva, and root coverage were recorded before surgery (baseline) and 6 months and 1 year postoperatively.

RESULTS

Statistically significant improvements were found for gingival recession, attachment level, and root coverage from baseline to 6 months and 1 year postoperatively in both groups. Both procedures produced the same average reduction in gingival recession, gain in attachment level, and amount of root coverage after 1 year. Probing depths did not differ between groups throughout the study. The width of keratinized gingiva was significantly greater in the grafted group than in the guided tissue regeneration group.

CONCLUSION

Both procedures produced the same average amount of root coverage, reduction in gingival recession, and gain in clinical attachment. The guided tissue regeneration procedure provided a better esthetic appearance without any difference in gingival color or architecture in cases of adjacent facial gingival recession.

Changes of liver fibrosis in chronic hepatitis C patients with no response to interferon-alpha therapy: including quantitative assessment by a morphometric method

The aim of this study was to evaluate the antifibrotic effect of interferon (IFN)-alpha in chronic hepatitis C (CH-C) patients with no response to IFN-alpha therapy. We studied 76 patients (46 men, 30 women; mean age, 55.6 years) who received IFN-alpha intramuscularly, at a total close of 480 to 880MU for 6 months (group A). As a control group, we studied 50 patients (32 men and 18 women; mean age, 58.5 years) with CH-C who received medication other than IFN (ie, Strong-Neo-Minophagen C, ursodeoxycholic acid, and a herbal medicine, Sho-saiko-to [TJ-9]) and who had persistent alanine aminotransferase (ALT) elevation (group B). All patients were subdivided into three subgroups according to different patterns of ALT changes during the observation period, ie, (a) persistent ALT level < 60IU/ 1 (below about twice the upper limit of the normal range), (b) persistent ALT level > or = 60IU/1, (c) ALT levels other than (a) and (b). Liver biopsy was performed within 6 months prior to IFN therapy and more than 6 months after IFN therapy, while two liver biopsies were performed during therapy in group B. Liver fibrosis was compared between two specimens by staging. When the fibrosis stage was the same in the two specimens, we determined whether the fibrosis had improved or worsened by comparing the fibrotic ratio, ie, the ratio of the area of fibrosis to the area of the entire liver tissue specimen, calculated using computed graphic software. Serum aminoterminal peptide of type III procollagen (PIIIP) levels were measured on the day of the liver biopsy and their mean yearly changes were compared between the two groups. Improvement of liver fibrosis was found in 12% to 30% of patients in each ALT subgroup and in 24% of all patients in group A and there were no significant differences in liver fibrosis in comparison with findings in of group B when assessed by staging alone. However, these percentages rose to 59% to 75% and 66%, respectively, when liver fibrosis was assessed by the fibrotic ratio together with staging, resulting in a significant difference in fibrosis between groups A and B in total (P < 0.01). The mean yearly changes in serum PIIIP levels in each subgroup and in all patients in group A were below zero, indicating a tendency to improvement of fibrosis after IFN therapy, while these changes in group B were all above zero, except for subgroup (c). Improvement of fibrosis after IFN therapy was found in 15 of 24 patients (64%) whose ALT changes had the same pattern before and after IFN therapy, although no significant difference was noted between improved and worsened patients. These results suggest that IFN-alpha may have an antifibrotic effect even in CH-C patients with no overt response to IFN-alpha therapy, compared with the effect of medications other than IFN.

Improvement of multiple facial gingival recession by non-surgical and supportive periodontal therapy: a case report

We report a case of multiple facial gingival recession which was improved by non-surgical and supportive periodontal therapy. The patient, a 28-year-old Japanese woman, presented for treatment of multiple facial gingival recession ranging from 1 to 4 mm on teeth 5 through 12 and 19 through 30. Periodontal plastic surgery to cover the exposed multiple root surfaces was suggested. However, because of emotional problems, the patient did not wish to undergo the procedures and instead accepted non-surgical periodontal therapy including oral hygiene instruction, scaling, and root planing. The exposed root sites were monitored at periodic maintenance visits, and gradual improvement through a coronal increase of the gingival margin was noted. The possible etiologic factors and healing process associated with this case are discussed.