Identification of the Cirratiomycin Biosynthesis Gene Cluster in Streptomyces Cirratus: Elucidation of the Biosynthetic Pathways for 2,3-Diaminobutyric Acid and Hydroxymethylserine

Cirratiomycin, a heptapeptide with antibacterial activity, was isolated and characterized in 1981; however, its biosynthetic pathway has not been elucidated. It contains several interesting nonproteinogenic amino acids, such as (2S,3S)-2,3-diaminobutyric acid ((2S,3S)-DABA) and α-(hydroxymethyl)serine, as building blocks. Here, we report the identification of a cirratiomycin biosynthetic gene cluster in Streptomyces cirratus. Bioinformatic analysis revealed that several Streptomyces viridifaciens and Kitasatospora aureofaciens strains also have this cluster. One S. viridifaciens strain was confirmed to produce cirratiomycin. The biosynthetic gene cluster was shown to be responsible for cirratiomycin biosynthesis in S. cirratus in a gene inactivation experiment using CRISPR-cBEST. Interestingly, this cluster encodes a nonribosomal peptide synthetase (NRPS) composed of 12 proteins, including those with an unusual domain organization: a stand-alone adenylation domain, two stand-alone condensation domains, two type II thioesterases, and two NRPS modules that have no adenylation domain. Using heterologous expression and in vitro analysis of recombinant enzymes, we revealed the biosynthetic pathway of (2S,3S)-DABA: (2S,3S)-DABA is synthesized from l-threonine by four enzymes, CirR, CirS, CirQ, and CirB. In addition, CirH, a glycine/serine hydroxymethyltransferase homolog, was shown to synthesize α-(hydroxymethyl)serine from d-serine in vitro. These findings broaden our knowledge of nonproteinogenic amino acid biosynthesis.

Synthesis of the MN Ring of Caribbean Ciguatoxin C-CTX-1 via Desymmetrization by Acetal Formation

The MN ring of Caribbean ciguatoxin C-CTX-1 was synthesized from a meso-syn-2,7-dimethyloxepane derivative corresponding to the M ring via desymmetrization by acetal formation with a camphor derivative, followed by construction of the N ring via the Horner-Wadsworth-Emmons reaction and acetal formation. The meso-syn-2,7-dimethyloxepane derivative was synthesized via photoinduced electrocyclization of a conjugated exo-diene under flow conditions, giving a cyclobutene derivative, followed by ring expansion via oxidative cleavage and diastereoselective reduction of a β-hydroxy ketone.

Substrate-Dependent Alteration in the C- and O-Prenylation Specificities of Cannabis Prenyltransferase

CsPT4 is an aromatic prenyltransferase that synthesizes cannabigerolic acid (CBGA), the key intermediate of cannabinoid biosynthesis in Cannabis sativa, from olivetolic acid (OA) and geranyl diphosphate (GPP). CsPT4 has a catalytic potential to produce a variety of CBGA analogs via regioselective C-prenylation of aromatic substrates having resorcylic acid skeletons including bibenzyl 2,4-dihydroxy-6-phenylethylbenzoic acid (DPA). In this study, we further investigated the substrate specificity of CsPT4 using phlorocaprophenone (PCP) and 2',4',6'-trihydroxydihydrochalcone (THDC), the isomers of OA and DPA, respectively, and demonstrated that CsPT4 catalyzed both C-prenylation and O-prenylation reactions on PCP and THDC that share acylphloroglucinol substructures. Interestingly, the kinetic parameters of CsPT4 for these substrates differed depending on whether they underwent C-prenylation or O-prenylation, suggesting that this enzyme utilized different substrate-binding modes suitable for the respective reactions. Aromatic prenyltransferases that catalyze O-prenylation are rare in the plant kingdom, and CsPT4 was notable for altering the reaction specificity between C- and O-prenylations depending on the skeletons of aromatic substrates. We also demonstrated that enzymatically synthesized geranylated acylphloroglucinols had potent antiausterity activity against PANC-1 human pancreatic cancer cells, with 4'-O-geranyl THDC being the most effective. We suggest that CsPT4 is a valuable catalyst to generate biologically active C- and O-prenylated molecules that could be anticancer lead compounds.

Catalytic Potential of Cannabis Prenyltransferase to Expand Cannabinoid Scaffold Diversity

Biologically active cannabinoids are derived from cannabigerolic acid (CBGA), which is biosynthesized by aromatic prenyltransferase CsPT4. We exploit the catalytic versatility of CsPT4 to synthesize various CBGA analogues, including a geranylated bibenzyl acid, the precursor to bibenzyl cannabinoids of liverwort origin. The synthesized natural and new-to-nature cannabinoids exhibit potent cytotoxicity in human pancreatic cancer cells. CsPT4 can artificially extend the cannabinoid biosynthetic diversity with novel and improved biological activities.

A [4Fe-4S] cluster resides at the active center of phosphomevalonate dehydratase, a key enzyme in the archaeal modified mevalonate pathway

The recent discovery of the archaeal modified mevalonate pathway revealed that the fundamental units for isoprenoid biosynthesis (isopentenyl diphosphate and dimethylallyl diphosphate) are biosynthesized via a specific intermediate, trans-anhydromevalonate phosphate. In this biosynthetic pathway, which is unique to archaea, the formation of trans-anhydromevalonate phosphate from (R)-mevalonate 5-phosphate is catalyzed by a key enzyme, phosphomevalonate dehydratase. This archaea-specific enzyme belongs to the aconitase X family within the aconitase superfamily, along with bacterial homologs involved in hydroxyproline metabolism. Although an iron–sulfur cluster is thought to exist in phosphomevalonate dehydratase and is believed to be responsible for the catalytic mechanism of the enzyme, the structure and role of this cluster have not been well characterized. Here, we reconstructed the iron–sulfur cluster of phosphomevalonate dehydratase from the hyperthermophilic archaeon Aeropyrum pernix to perform biochemical characterization and kinetic analysis of the enzyme. Electron paramagnetic resonance, iron quantification, and mutagenic studies of the enzyme demonstrated that three conserved cysteine residues coordinate a [4Fe-4S] cluster—as is typical in aconitase superfamily hydratases/dehydratases, in contrast to bacterial aconitase X-family enzymes, which have been reported to harbor a [2Fe-2S] cluster.

Formylation Reaction of Amines Using N-Formylcarbazole

Formamides are useful starting materials for pharmaceutical syntheses. Although various synthetic methods have been documented in this regard, the use of N-formylcarbazole as a formylation reagent for amines has not yet been reported. We report here the first examples of the use of N-formylcarbazole for the formylation of amines. The characteristic reactivity of N-formylcarbazole enables the selective formylation of sterically less hindered aliphatic primary and secondary amines. In contrast, sterically bulkier amines and weakly nucleophilic amines such as anilines are less reactive under the reaction conditions.

Insight into the mechanism of geranyl-β-phellandrene formation catalyzed by Class IB terpene synthases

Terpene synthase (TS) from Bacillus alcalophilus (BalTS) is the only Class IB TS for which a 3D structure has been elucidated. Recently, geranyl-β-phellandrene, a novel cyclic diterpene, was identified as a product of BalTS in addition to the acyclic β-springene. In the present study, we have provided insight into the mechanism of geranyl-β-phellandrene formation. Deuterium labeling experiments revealed that the compound is produced via a 1,3-hydride shift. In addition, nonenzymatic reactions using divalent metal ions were performed. The enzyme is essential for the geranyl-β-phellandrene formation. Furthermore, BalTS variants targeting tyrosine residues enhanced the yield of geranyl-β-phellandrene and the proportion of the compound of the total products. It was suggested that the expansion of the active site space may allow the conformation of the intermediates necessary for cyclization. The present study describes the first Class IB TSs to successfully alter product profiles while retaining high enzyme activity.

Stereoselective Syntheses of trans-Anhydromevalonic Acid and trans-Anhydromevalonyl Group-Containing Natural Products

Collective total syntheses of trans-anhydromevalonic acid (tAHMA) and trans-anhydromevalonyl (tAHM) group-containing natural products (pestalotiopin A, pestalotiopamide C, pestalotiopamide D, farinomalein E, eleutherazine B, and trichocyclodipeptide A) were achieved using tAHMA esters as key intermediates. To this end, tAHMA tert-butyl ester was newly prepared by Z-vinyltosylation of tert-butyl 3-oxo-5-((triisopropylsilyl)oxy)pentanoate followed by the Negishi cross-coupling reaction with Me₂Zn. tAHMA esters were converted to the target natural products via esterification or amidation. Comparison of the spectroscopic data of synthetic and natural products confirmed the E-configuration of the tAHM moieties in the natural products.

Total Synthesis and Structure Confirmation of trans-Anhydromevalonate-5-phosphate, a Key Biosynthetic Intermediate of the Archaeal Mevalonate Pathway

The mevalonate pathway is an upstream terpenoid biosynthetic route of terpenoids for providing the two five-carbon units, dimethylallyl diphosphate, and isopentenyl diphosphate. Recently, trans-anhydromevalonate-5-phosphate (tAHMP) was isolated as a new biosynthetic intermediate of the archaeal mevalonate pathway. In this study, we would like to report the first synthesis of tAHMP and its enzymatic transformation using one of the key enzymes, mevalonate-5-phosphate dehydratase from a hyperthermophilic archaeon, Aeropyrum pernix. Starting from methyl tetrolate, a Cu-catalyzed allylation provided an E-trisubstituted olefin in a stereoselective manner. The resulting E-olefin was transformed to tAHMP by cleavage of the olefin and phosphorylation. The structure of the synthetic tAHMP was unambiguously determined by NOESY analysis.

Selective oxidation of alcohol-d 1 to aldehyde-d 1 using MnO2

The selective oxidation of alcohol-d₁ to prepare aldehyde-d₁ was newly developed by means of NaBD₄ reduction/activated MnO₂ oxidation. Various aldehyde-d₁ derivatives including aromatic and unsaturated aldehyde-d₁ can be prepared with a high deuterium incorporation ratio (up to 98% D). Halogens (chloride, bromide, and iodide), alkene, alkyne, ester, nitro, and cyano groups in the substrates are tolerated under the mild conditions.

A facile method for deutrium incorporation into aldehydes by mild reduction of NaBD₄ of aldehydes and MnO₂ oxidation (98% D) is disclosed.

Ovicidal activity of juvenile hormone mimics in the bean bug, Riptortus pedestris

Insect juvenile hormone (JH) mimics (JHMs) are known to have ovicidal effects if applied to adult females or eggs. Here, we examined the effects of exogenous JHMs on embryonic development of the bean bug, Riptortus pedestris. The expression profiles of JH early response genes and JH biosynthetic enzymes indicated that JH titer was low for the first 3 days of the egg stage and increased thereafter. Application of JH III skipped bisepoxide (JHSB₃) or JHM on Day 0 eggs when JH titer was low caused reduced hatchability, and the embryos mainly arrested in mid- or late embryonic stage. Application of JHMs on Day 5 eggs also resulted in an arrest, but this was less effective compared with Day 0 treatment. Interestingly, ovicidal activity of synthetic JHMs was much lower than that of JHSB₃. This study will contribute to developing novel insecticides that are selective among insect species.

A novel cyclic peptide (Naturido) modulates glia-neuron interactions in vitro and reverses ageing-related deficits in senescence-accelerated mice

The use of agents that target both glia and neurons may represent a new strategy for the treatment of ageing disorders. Here, we confirmed the presence of the novel cyclic peptide Naturido that originates from a medicinal fungus (Isaria japonica) grown on domestic silkworm (Bombyx mori). We found that Naturido significantly enhanced astrocyte proliferation and activated the single copy gene encoding the neuropeptide VGF and the neuron-derived NGF gene. The addition of the peptide to the culture medium of primary hippocampal neurons increased dendrite length, dendrite number and axon length. Furthermore, the addition of the peptide to primary microglial cultures shifted CGA-activated microglia towards anti-inflammatory and neuroprotective phenotypes. These findings of in vitro glia–neuron interactions led us to evaluate the effects of oral administration of the peptide on brain function and hair ageing in senescence-accelerated mice (SAMP8). In vivo analyses revealed that spatial learning ability and hair quality were improved in Naturido-treated mice compared with untreated mice, to the same level observed in the normal ageing control (SAMR1). These data suggest that Naturido may be a promising glia–neuron modulator for the treatment of not only senescence, but also Alzheimer’s disease and other neurodegenerative diseases.

Diverse Aromatic Metabolites in the Solitary Tunicate Cnemidocarpa irene

Fourteen aromatic metabolites (6-19) were isolated from an aqueous extract of the solitary tunicate Cnemidocarpa irene collected in Hokkaido, Japan. The structures of the metabolites were determined based on the spectroscopic interpretations, including one- and two-dimensional NMR, mass spectra, UV, and circular dichroism data. The biopterin analogue 10 modulated the behavior of mice after intracerebroventricular injection and showed a weak affinity to ionotropic glutamate receptor subtypes. Analyses of fluorescent coelomic fluid of the tunicate revealed that pterin 12 was responsible for the fluorescence of the blood cells, while β-carbolines 1 and 3 were fluorescent compounds in the serum. The metabolic profiles in adults, juveniles, larvae, and eggs of the animal differed substantially, suggesting that the metabolism of the animal, especially biosynthesis of aromatic secondary metabolites, changes over different life stages.

Characterization of Class IB Terpene Synthase: The First Crystal Structure Bound with a Substrate Surrogate

Terpene synthases (TS) are classified into two broad types, Class I and II, based on the chemical strategy for initial carbocation formation and motif sequences of the catalytic site. We have recently identified a new class of enzymes, Class IB, showing the acceptability of long (C₂₀-C₃₅) prenyl-diphosphates as substrates and no amino acid sequence homology with known TS. Conversion of long prenyl-diphosphates such as heptaprenyl-diphosphate (C₃₅) is unusual and has never been reported for Class I and II enzymes. Therefore, the characterization of Class IB enzymes is crucial to understand the reaction mechanism of the extensive terpene synthesis. Here, we report the crystal structure bound with a substrate surrogate and biochemical analysis of a Class IB TS, using the enzyme from Bacillus alcalophilus (BalTS). The structure analysis revealed that the diphosphate part of the substrate is located around the two characteristic Asp-rich motifs, and the hydrophobic tail is accommodated in a unique hydrophobic long tunnel, where the C₃₅ prenyl-diphosphate, the longest substrate of BalTS, can be accepted. Biochemical analyses of BalTS showed that the enzymatic property, such as Mg²⁺ dependency, is similar to those of Class I enzymes. In addition, a new cyclic terpene was identified from BalTS reaction products. Mutational analysis revealed that five of the six Asp residues in the Asp-rich motifs and two His residues are essential for the formation of the cyclic skeleton. These results provided a clue to consider the application of the unusual large terpene synthesis by Class IB enzymes.

Catalytic Asymmetric Hydrogenation of Dehydroamino Acid Esters with Biscarbamate Protection and Its Application to the Synthesis of xCT Inhibitors

Catalytic asymmetric hydrogenation of dehydroamino acid esters with biscarbamate protection was examined for the first time to prepare optically active amino acids. The new method was successfully applied to the synthesis of new cystine-glutamate exchanger inhibitors.

An Aromatic Farnesyltransferase Functions in Biosynthesis of the Anti-HIV Meroterpenoid Daurichromenic Acid

Rhododendron dauricum produces daurichromenic acid, an anti-HIV meroterpenoid, via oxidative cyclization of the farnesyl group of grifolic acid. The prenyltransferase (PT) that synthesizes grifolic acid is a farnesyltransferase in plant specialized metabolism. In this study, we demonstrated that the isoprenoid moiety of grifolic acid is derived from the 2-C-methyl-d-erythritol-4-phosphate pathway that takes place in plastids. We explored candidate sequences of plastid-localized PT homologs and identified a cDNA for this PT, RdPT1, which shares moderate sequence similarity with known aromatic PTs. RdPT1 is expressed exclusively in the glandular scales, where daurichromenic acid accumulates. In addition, the gene product was targeted to plastids in plant cells. The recombinant RdPT1 regiospecifically synthesized grifolic acid from orsellinic acid and farnesyl diphosphate, demonstrating that RdPT1 is the farnesyltransferase involved in daurichromenic acid biosynthesis. This enzyme strictly preferred orsellinic acid as a prenyl acceptor, whereas it had a relaxed specificity for prenyl donor structures, also accepting geranyl and geranylgeranyl diphosphates with modest efficiency to synthesize prenyl chain analogs of grifolic acid. Such a broad specificity is a unique catalytic feature of RdPT1 that is not shared among secondary metabolic aromatic PTs in plants. We discuss the unusual substrate preference of RdPT1 using a molecular modeling approach. The biochemical properties as well as the localization of RdPT1 suggest that this enzyme produces meroterpenoids in glandular scales cooperatively with previously identified daurichromenic acid synthase, probably for chemical defense on the surface of R. dauricum plants.

Crystal structure and functional analysis of large-terpene synthases belonging to a newly found subclass

The first crystal structure of a large-terpene synthase elucidated two novel Asp rich motifs and a new subclass of terpene synthases.

Thousands of terpenes have been identified to date. However, only two classes of enzymes are known to be involved in their biosynthesis, and each class has characteristic amino-acid motifs. We recently identified a novel large-terpene (C₂₅/C₃₀/C₃₅) synthase, which shares no motifs with known enzymes. To elucidate the molecular mechanism of this enzyme, we determined the crystal structure of a large-β-prene synthase from B. alcalophilus (BalTS). Surprisingly, the overall structure of BalTS is similar to that of the α-domain of class I terpene synthases although their primary structures are totally different from each other. Two novel aspartate-rich motifs, DYLDNLxD and DY(F,L,W)IDxxED, are identified, and mutations of any one of the aspartates eliminate its enzymatic activity. The present work leads us to propose a new subclass of terpene synthases, class IB, which is probably responsible for large-terpene biosynthesis.

Upregulation of Juvenile Hormone Titers in Female Drosophila melanogaster Through Mating Experiences and Host Food Occupied by Eggs and Larvae

Juvenile hormone (JH) plays a crucial role in the determination of developmental timing in insects. In Drosophila melanogaster, reports indicate that JH titers are the highest immediately following eclosion and that the mating experience increases the titers in females. However, the titers have not been successively measured for an extended period of time after eclosion. This study reveals that JH titers are increased after eclosion in virgin females when supplied with food that is occupied by eggs and larvae as well as in mated females. With the presence of eggs and larvae, food induced the virgin females to lay unfertilized eggs. When combined with previous work indicating that females are attracted to such food where they prefer to lay eggs, these results suggest that flies can prepare themselves to lay eggs by changing the titers of JH under the presence of growing larvae, ensuring that the food is an appropriate place to oviposit.

The stereoselective construction of E- and Z-Δ-Ile from E-dehydroamino acid ester: the synthesis of the phomopsin A tripeptide side chain

The synthesis of the phomopsin A tripeptide side chain was achieved by the stereoselective construction of E-Δ-Ile and E-Δ-Asp using α-(diphenylphosphono)glycine.

(7S)-Kaitocephalin as a potent NMDA receptor selective ligand

A structure–activity relationship (SAR) study of kaitocephalin, known to be a potent naturally occurring NMDA receptor ligand, was performed.

Three-dimensional optical coherence tomography of proliferative diabetic retinopathy

Fourier-domain optical coherence tomography (OCT) was used to image the three-dimensional (3D) structures of the proliferative membrane in proliferative diabetic retinopathy. The case of a 51-year-old man with retinal detachment of the macula in his left eye is reported. The proliferative membrane covered the entire macular area. In the OCT image, the 3D structure of the proliferative membrane could be clearly visualised. The OCT image showed the presence of multiple adhesions between the retina and the proliferative membrane and separation of the proliferative membrane. The patient underwent three-port vitrectomy, and the extent and locations of the adhesions corresponded well with the findings during vitrectomy. Three-dimensional OCT is an effective tool for understanding the 3D structure of the proliferative membrane in diabetic retinopathy and is useful for training and planning of the surgical procedures in vitrectomy. To view the full report and accompanying video please go to: http://bjo.bmj.com/cgi/content/full/92/5/713/DC1. All videos from the BJO video report collection are available from: http://bjo.bmj.com/video/collection.dtl.

Spectral interferometric optical coherence tomography with nonlinear beta-barium borate time gating

A high-speed, all optical coherence tomography system was designed and constructed. This tomography system employs spectral interferometry and optical Fourier transformation to reduce the number of mechanical scanning dimensions required for multidimensional profilometry. The system also employs a time gate comprising a beta -barium borate crystal driven by a femtosecond laser pulse to improve measurement time. This system has 43-mum depth resolution and 150-fs temporal resolution and is capable of taking 1000 cross-sectional image frames per second.

Birefringence imaging of human skin by polarization-sensitive spectral interferometric optical coherence tomography

We have developed a spectral interferometric optical coherence tomography (OCT) system with polarization sensitivity that is able to measure a two-dimensional tomographic image by means of one-dimensional mechanical scanning. Our system, which has an axial resolution of 32 mum , calculates the distribution of each element of the Müller matrix of a measured object from 16 OCT images. The OCT system successfully reveals the birefringent nature of human skin tissue.

Occlusive arterial diseases of the upper and lower extremities found in workers occupationally exposed to vibrating tools

Hand-arm vibration syndrome (HAVS) is primarily a disorder of the fingers and hands. However, in some cases, vibration-exposed workers are observed to have also episodic blanching of the hands and feet. In latter cases, arteriographies of both the upper and lower extremities are necessary to diagnose the background arterial disorders. In this study, eight HAVS subjects with such disorders were examined by arteriography for differential diagnosis in cases of workers' accident compensation. In three HAVS cases with thromboangiitis obliterans, the arteriographic examination revealed obstructive changes in the palm and forearm as well as three below-knee lesions in the lower extremities. In five HAVS cases with arteriosclerosis obliterans, obstruction kinking or coiling, stenosis and/or tapering-off of the proper digital arteries were observed together with two below-knee lesions and three high lesions in the lower extremities. From the viewpoint of occupational health, palpation of superficial arteries of both the upper and lower extremities should be routinely performed during both pre-placement and periodic medical examinations for workers exposed to vibrating tools for early detection and/or prevention of any worsening of the background disorders.

Phase-resolved correlation and its application to analysis of low-coherence interferograms

A new signal-processing technique is proposed that involves a phase-resolved correlation method that one can use to determine the phase distribution of low-coherence interferograms. This method improves the sensitivity and resolution of low-coherence interferometers. The depth structure of an aluminum oxide-coated aluminum mirror was determined by use of a low-coherence interferometer with this method. Three signal peaks were successfully extracted from a noisy interferogram.

A new monitor with a zinc-oxide thin film semiconductor sensor for the measurement of volatile sulfur compounds in mouth air

Halitosis, defined as unpleasant oral odor, is a concern among the general public. Halitosis is generally diagnosed by organoleptic examination and by gas chromatographic analysis of the main source of halitosis, volatile sulfur compounds, such as hydrogen sulfide, methyl mercaptan, and dimethyl sulfide. Gas chromatography requires a large-scale system and a long running time. We investigated the use of a zinc-oxide thin film semiconductor sensor for measuring trace volatile sulfur compounds in mouth air. Mouth air samples collected in teflon bags from 21 volunteers were analyzed by 3 methods: the monitor analysis, gas chromatography, and organoleptic examination by 3 judges. The readings of the monitor were correlated with the values of the total volatile sulfur compounds measured by gas chromatography (r = 0.75, P < 0.01) and also with the organoleptic scores given by the judges (r = 0.76, P < 0.01). The organoleptic scores were correlated with the gas chromatographic values (r = 0.71, P < 0.01). These results suggest that this new monitor with a zinc-oxide thin film semiconductor sensor may be used for the diagnosis of halitosis. Its small size and simplicity of handling may enable its use for routine chair-side study and field surveys of halitosis.

Re-evaluation of capillaroscopy of finger nailfold in vibration-exposed workers

Two hundred and ninety-four vibration-exposed workers were examined for vibration disease (VD) for the worker's accident compensation. Most subjects were male. Their ages ranged from 24 to 68 years. Duration of vibration exposure ranged from 3 to 30 years. After acclimatization at 25 degrees C to 27 degrees C for at least an hour, the nailfold capillaries of the ring (or middle) finger were studied with a light microscope. A cold water immersion test (5 degrees C, 10 min) was then performed. The morphological findings of the nailfold capillaries were classified based on the criteria by Fagrell & Lundberg. A hundred and eighty subjects were diagnosed as VD and 75 as non VD, even without taking the capillaroscopic findings into consideration. The classification of the capillarograms retrospectively investigated were as follows, i.e. in 98 VD subjects 40 cases were stage A, 42 stage B, and 16 cases stage C. In 26 nonVD subjects 13 cases were stage A, 10 stage B, and 3 cases stage C, respectively. When the borderline of VD and nonVD existed between stage A and stages B and C, the sensitivity was 59.2%, specificity was 50.0%, and false positive and negative were 50.0% and 40.8%. Relationship between the capillary stage and recovery (%) of the skin temperature during the cold water immersion test was also studied. The recovery in stage C was not always lower than that in stage A. Among them, arteriography was performed in 57 cases. Despite the use of vasodilator, markedly delayed perfusion of the finger tips was observed in 28 cases. Their capillary stages were A in 12 cases, B in 11 and C in 3. The peripheral microcirculatory state in VD should be carefully evaluated in combination with appropriately selected examinations, including finger nailfold capillaroscopy.

Clinical characteristics of halitosis: differences in two patient groups with primary and secondary complaints of halitosis

Halitosis, defined as an unpleasant oral odor, has become a health concern among the general public. The objective of this study was to evaluate the diversity of clinical characteristics of halitosis of the patients who visited dental clinics. Sixty-eight patients with primary complaints of halitosis and 19 patients with primary complaints of periodontal diseases but secondary complaints of halitosis were studied by organoleptic examination. The patients with primary complaints were diagnosed as having halitosis in fewer cases than the patients with secondary complaints-25% and 53%, respectively. Patient complaints for halitosis were further categorized, by questionnaire, into three types: Type 1, self-conscious; Type 2, conscious by the indication of others; and Type 3, conscious by presumptions from the attitude of others. Although 80% of the patients of both groups were of Type 1, only 24.1% of the Type 1 patients with primary complaint, in comparison with 50% of the Type 1 patients with secondary complaint, were actually found to have halitosis. The results suggest that the majority of patients with primary complaints of halitosis at the dental clinic did not actually have halitosis, but suffered from an imaginary halitosis due to presumptions based upon others' attitudes. After treatment, these patients were more likely to be dissatisfied than patients who had visited the clinic with halitosis as their secondary complaint.

Hypothenar hammer syndrome in workers occupationally exposed to vibrating tools

Among 330 vibration-exposed workers, 24 cases of hypothenar hammer syndrome in 29 hands were diagnosed by arteriography. The right hand was involved in 13, the left hand in six, and both hands in five cases. The mean age was 55 years, mean duration of vibration exposure 19.4 years, and mean duration of episodic Raynaud's phenomenon 6.4 years. The vascular lesions of the ulnar arteries were classified into three major types with subtypes. Type 1: stenosis of the superficial palmar arch around the hook of the hamate. Type 2a: occlusion of the superficial palmar arch around the hook of the hamate. Type 2b: occlusion of both superficial and deep palmar arches around the hook of the hamate. Type 3a: occlusion of the ulnar artery at the proximal part of the wrist. Type 3b: occlusion of the ulnar artery near the wrist with the occlusion of the dorsal carpal branch of the ulnar artery.