Employment status and contributing factors among adults with congenital heart disease in Japan

BACKGROUND

Working is an important concern in transitional care for adults with congenital heart disease (ACHD) because work connects people with society. Employment status is correlated with gender, but studies on patient employment by gender have rarely been conducted. This study therefore aimed to examine the employment status of ACHD by gender and to explore the factors influencing this status.

METHODS

In this study, 193 Japanese ACHD (mean age: men-33.62 years, women-32.69 years; 89 men, no students included) completed a questionnaire including questions about employment status, an evaluation of hindrances to employment, the Linear Analog Scale to assess quality of life (QOL), and the Satisfaction with Life Scale (SWLS).

RESULTS

In the study sample, 13 of 89 (14.6%) men and 13 of 104 (12.5%) women did not have a job. These rates were higher than the national standard rates in Japan (men: 5.0%, women: 2.9%). Of these patients, only one man and one woman listed their illness as a reason for their unemployment. The factors thought to explain unemployment were age for men and disease severity for women (P < 0.05 for both). Unemployed patients had significantly lower QOL and SWLS scores.

CONCLUSIONS

Most ACHD can join the workforce but a higher percentage of ACHD do not work and find it challenging to have a career compared with the general population. Moreover, because unemployed patients have low QOL and SWLS scores, obtaining work is crucial to enable these people to have mentally and emotionally stable and fulfilling lives.

A SR-NET 3D-TO-2D ARCHITECTURE FOR PARASEPTAL EMPHYSEMA SEGMENTATION

Paraseptal emphysema (PSE) is a relatively unexplored emphysema subtype that is usually asymptomatic, but recently associated with interstitial lung abnormalities which are related with clinical outcomes, including mortality. Previous local-based methods for emphysema subtype quantification do not properly characterize PSE. This is in part for their inability to properly capture the global aspect of the disease, as some the PSE lesions can involved large regions along the chest wall. It is our assumption, that path-based approaches are not well-suited to identify this subtype and segmentation is a better paradigm. In this work we propose and introduce the Slice-Recovery network (SR-Net) that leverages 3D contextual information for 2D segmentation of PSE lesions in CT images. For that purpose, a novel convolutional network architecture is presented, which follows an encoding-decoding path that processes a 3D volume to generate a 2D segmentation map. The dataset used for training and testing the method comprised 664 images, coming from 111 CT scans. The results demonstrate the benefit of the proposed approach which incorporate 3D context information to the network and the ability of the proposed method to identify and segment PSE lesions with different sizes even in the presence of other emphysema subtypes in an advanced stage.

Efficacy of primary treatment with immunoglobulin plus ciclosporin for prevention of coronary artery abnormalities in patients with Kawasaki disease predicted to be at increased risk of non-response to intravenous immunoglobulin (KAICA): a randomised controlled, open-label, blinded-endpoints, phase 3 trial

BACKGROUND

Genetic studies have indicated possible involvement of the upregulated calcium-nuclear factor of activated T cells pathway in the pathogenesis of Kawasaki disease. We aimed to assess safety and efficacy of ciclosporin, an immunosuppressant targeting this pathway, for protection of patients with Kawasaki disease against coronary artery abnormalities.

METHODS

We did a randomised, open-label, blinded endpoints trial involving 22 hospitals in Japan between May 29, 2014, and Dec 27, 2016. Eligible patients predicted to be at higher risk for intravenous immunoglobulin (IVIG) resistance were randomly assigned to IVIG plus ciclosporin (5 mg/kg per day for 5 days; study treatment) or IVIG (conventional treatment) groups, stratified by risk score, age, and sex. The primary endpoint was incidence of coronary artery abnormalities using Japanese criteria during the 12-week trial, assessed in participants who received at least one dose of study drug and who visited the study institution at least once during treatment. This trial is registered to Center for Clinical Trials, Japan Medical Association, number JMA-IIA00174.

FINDINGS

We enrolled 175 participants. One patient withdrew consent after enrolment and was excluded and one patient (in the study treatment group) was excluded from analysis because of lost echocardiography data. Incidence of coronary artery abnormalities was lower in the study treatment group than in the conventional treatment group (12 [14%] of 86 patients vs 27 [31%] of 87 patients; risk ratio 0·46; 95% CI 0·25-0·86; p=0·010). No difference was found in the incidence of adverse events between the groups (9% vs 7%; p=0·78).

INTERPRETATION

Combined primary therapy with IVIG and ciclosporin was safe and effective for favourable coronary artery outcomes in Kawasaki disease patients who were predicted to be unresponsive to IVIG.

FUNDING

Japan Agency for Medical Research and Development (grant CCT-B-2503).

Search for Boosted Dark Matter Interacting with Electrons in Super-Kamiokande

A search for boosted dark matter using 161.9 kt yr of Super-Kamiokande IV data is presented. We search for an excess of elastically scattered electrons above the atmospheric neutrino background, with a visible energy between 100 MeV and 1 TeV, pointing back to the Galactic center or the Sun. No such excess is observed. Limits on boosted dark matter event rates in multiple angular cones around the Galactic center and Sun are calculated. Limits are also calculated for a baseline model of boosted dark matter produced from cold dark matter annihilation or decay. This is the first experimental search for boosted dark matter from the Galactic center or the Sun interacting in a terrestrial detector.

Surgical treatment for adult congenital heart disease: consideration for indications and procedures

The number of the adult patients with congenital heart diseases (ACHD) continues to grow owing to improvement of surgical results and medical management. Corrective surgery for complex CHD does not always mean complete cure. It is not rare that the patients will visit the cardiology institutes because of secondary lesions due to residua or sequela in adults. Some patients with CHD remain unrepairable with different degree of heart failure and pulmonary arterial hypertension. Association of arrhythmias is common in ACHD patients and sometimes critical. We experienced 265 surgical procedures for ACHD patients at our center between 1999 and 2015. Of these procedures, palliative surgery was performed in 3%, palliation to corrective surgery in 6%, primary repair in 57%, and redo surgery in 34%. Hospital mortality within 30 days in this period was 1.1%. Surgery for ACHD patients is safe, beneficial and low-risk treatment; however, tailored procedures for the individual patient are essential to obtain the optimal quality. A comprehensive multidisciplinary approach is required to fulfill this goal.

Dust particle diffusion in ion beam transport region

Dust particles of μm size produced by a monoplasmatron ion source are observed by a laser light scattering. The scattered light signal from an incident laser at 532 nm wavelength indicates when and where a particle passes through the ion beam transport region. As the result, dusts with the size more than 10 μm are found to be distributed in the center of the ion beam, while dusts with the size less than 10 μm size are distributed along the edge of the ion beam. Floating potential and electron temperature at beam transport region are measured by an electrostatic probe. This observation can be explained by a charge up model of the dust in the plasma boundary region.

Fluctuation of an ion beam extracted from an AC filament driven Bernas-type ion source

Argon ion beam fluctuation from an AC filament driven Bernas-type ion source is observed. The ion beam was measured by an 8 measurement elements beam profile monitor. The amplitude of the beam current fluctuation stayed in the same level from 100 Hz to 1 kHz of the filament heating frequency. The beam current fluctuation frequency measured by the beam profile monitor was equal to the frequency of the AC filament operation. The fluctuation amplitudes of the beam current by AC operation were less than 7% and were in the same level of the DC operation.

Sagittal focusing of synchrotron radiation X-rays using a winged crystal

A Si(111) winged crystal has been designed to minimize anticlastic bending and improve sagittal focusing efficiency. The crystal was thin with wide stiffening wings. The length-to-width ratio of the crystal was optimized by finite element analysis, and the optimal value was larger than the `golden value'. The analysis showed that the slope error owing to anticlastic bending is less than the Darwin width. The X-rays were focused two-dimensionally using the crystal and a tangentially bent mirror. The observed profiles of the focal spot agreed well with the results of a ray-tracing calculation in the energy range from 8 to 17.5 keV. X-ray diffraction measurements with a high signal-to-noise ratio using this focusing system were demonstrated for a small protein crystal.

Vasospastic angina in a 13-year-old female patient whose only symptom was toothache

Vasospastic angina was confirmed in a 13-year-old female patient at autopsy. The patient's only symptom was recurrent toothache, which began when she was 10 years old. In November 2000, she was evaluated at our medical center; however, all examinations were judged normal. Six months later, she suffered a severe toothache. She went to school the next morning after the symptoms improved. She lost consciousness at school and was given cardiopulmonary resuscitation but could not be revived. At autopsy, her three coronary vessels showed marked intimal hyperplasia, and multiple focal myocardial infarctions were observed in the lateral wall of the left ventricle. The patient's only clinical symptom was toothache and none of the physicians realized that this was caused by angina. Vasospastic angina begins at a young age and is one of the causes of sudden death in adolescents.

Estimation of the conduction velocity distribution of human sensory nerve fibers

A new method for estimating the distribution of conduction velocities (DCV) of peripheral nerve fibers has been developed. It also enables estimation of single nerve fiber action potential (SFAP), which agrees with the physiological knowledge. Two compound nerve action potentials (CAPs) elicited by electrical stimulation of a nerve bundle were recorded at different conduction distances. The distances between the stimulation and recording electrodes were measured on the skin surface along the nerve bundle. Starting with an arbitrary SFAP, the first estimated DCV was calculated from a CAP by the regularized non-negative least squares method. The next SFAP was then calculated by deconvolution of the other CAP and the estimated DCV. A lowpass filter with an appropriate cutoff frequency was used to obtain better conversion. The process was iterated until the CAP error defined as /CAP(calculated)-CAP/(2) was small enough. The conduction distances contained errors in measurement, especially in the distal segment, that distorted the estimated results. The Fibonacci search, therefore, was adopted to optimize the distance according to the CAP error. The accuracy of this method was demonstrated by a simulation study performed with two CAPs calculated from an arbitrary bimodal DCV and a biphasic SFAP to which a Gaussian white noise was added. The reliability of this method was checked in normal subjects by recording a pair of CAPs elicited by stimulation of the median nerve at the wrist and the elbow.

Striped iron zoning of olivine induced by dislocation creep in deformed peridotites

Deformation of solid materials affects not only their microstructures, but also their microchemistries. Although chemical unmixing of initially homogeneous multicomponent solids is known to occur during deformation by diffusion creep, there has been no report on their chemical zoning due to deformation by dislocation creep, in either natural samples or laboratory experiments. Here we report striped iron zoning of olivine ((Mg,Fe)2SiO4) in deformed peridotites, where the iron concentration increases at subgrain boundaries composed of edge dislocations. We infer that this zoning is probably formed by alignment of edge dislocations dragging a so-called Cottrell 'atmosphere' of solute atoms (iron in this case) into subgrain boundaries during deformation of the olivine by dislocation creep. We have found that the iron zoning does not develop in laboratory experiments of high strain rates where dislocations move too fast to drag the Cottrell atmosphere. This phenomenon might have important implications for the generation of deep-focus earthquakes, as transformation of olivine to high-pressure phases preferentially occurs in high-iron regions, and therefore along subgrain boundaries which would be preferentially aligned in plastically deformed mantle peridotites.

The relationships between trunk function and the findings of transcranial magnetic stimulation among patients with stroke

In this study, we investigated the relationship between the motor evoked potentials obtained from trunk muscles and the clinical function of trunk muscle. Twenty patients with unilateral hemispheric stroke and 11 healthy adults were examined. The responses of the bilateral external oblique muscles and the erector spinae muscles to the magnetic stimulation of multiple sites over both cortical hemispheres were recorded. Trunk muscle performance was assessed using the Trunk Control Test and Stroke Impairment Assessment Set. In the stroke group, stimulation of the affected hemisphere resulted in a motor evoked potential in only one patient, while the other 19 stroke patients produced no response to stimulation of the affected hemisphere. Stimulation of the unaffected hemisphere evoked bilateral responses in 19 patients. Further, stimulation of the unaffected hemisphere in the stroke group produced larger motor evoked potentials in the ipsilateral muscles than the motor evoked potentials recorded in the ipsilateral muscles of the control group. The clinical assessment scores of trunk function (i.e. Trunk Control Test and trunk items of Stroke Impairment Assessment Set) were correlated with the amplitudes of the motor evoked potentials of the ipsilateral external oblique muscle that were evoked by stimulation of the unaffected hemisphere. Our results suggest that the recovery of trunk function after stroke is associated with an increase in ipsilateral motor evoked potentials in the external oblique muscle upon stimulation of the unaffected hemisphere, suggesting a role for compensatory activation of uncrossed pathways in recovery of trunk function.

A new IFN-like cytokine, limitin, modulates the immune response without influencing thymocyte development

A novel IFN-like molecule, limitin, was recently identified and revealed to suppress B lymphopoiesis through the IFN-alphabeta receptor, although it lacked growth suppression on myeloid and erythroid progenitors. Here we have studied diverse effects of limitin on T lymphocytes and compared limitin with previously known IFNs. Like IFN-alpha and -beta, limitin modified immunity in the following responses. It suppressed mitogen- and Ag-induced T cell proliferation through inhibiting the responsiveness to exogenous IL-2 rather than suppressing the production of IL-2. In contrast, limitin enhanced cytotoxic T lymphocyte activity associated with the perforin-granzyme pathway. To evaluate the effect of limitin in vivo, a lethal graft-versus-host disease assay was established. Limitin-treatment of host mice resulted in the enhancement of graft-versus-host disease. Limitin did not influence thymocyte development either in fetal thymus organ cultures or in newborn mice injected with limitin-Ig, suggesting that limitin is distinguishable from IFN-alpha and -beta. From these findings, it can be speculated that the human homolog of limitin may be applicable for clinical usage because of its IFN-like activities with low adverse effects on, for example, T lymphopoiesis, erythropoiesis, and myelopoiesis.

Effects of risperidone on event-related potentials in schizophrenic patients

In order to examine the effects of risperidone on cognitive impairment in schizophrenia, event-related potentials (ERPs) were recorded before and after switching from conventional neuroleptics to risperidone in schizophrenic patients. ERPs were recorded during two auditory discrimination tasks (an oddball task and a distraction task) in 10 medicated schizophrenic patients during conventional neuroleptic and risperidone treatments. The amplitudes and latencies of N 100 and P300 component were measured in ERPs for target stimuli in the oddball task and in ERPs for target and novel stimuli in the distraction task. Although N 100 amplitude and latency and P 300 amplitude did not change significantly after switching the drug compared to that during conventional neuroleptic treatment, P 300 latency for target stimuli shortened significantly during risperidone treatment in both tasks, accompanied by the shortening of the reaction time in the distraction task. The P 300 latency change did not correlate with the change of the severity of psychopathology. These findings suggest that risperidone may speed the information processing in schizophrenic patients, contributing to the improvement of cognitive functions.

Cytokines prevent dexamethasone-induced apoptosis via the activation of mitogen-activated protein kinase and phosphatidylinositol 3-kinase pathways in a new multiple myeloma cell line

A new human myeloma cell line, OPM-6, was established from the peripheral blood of a patient with advanced IgG-kappa plasma cell leukemia. Cytogenetic and phenotypic analysis confirmed that the cells were derived from the patient's leukemic cells. Insulin-like growth factor-1 (IGF-1) acts as an autocrine growth factor in these cells. In addition, OPM-6 cells were particularly sensitive to dexamethasone (DEX), when endogenous IGF-1 was blocked. Under these conditions, >95% of the DEX-treated cells died within 36 h. Therefore, OPM-6 represents a potentially powerful tool for the analysis of the molecular mechanisms of DEX-induced apoptosis, because it is possible to easily analyze the direct effects of DEX using this system. Using this culture system of OPM-6, we demonstrated that the treatment with DEX plus a monoclonal antibody to the human IGF-1 receptor (alphaIGF-1R) leads to the down-regulation of the gene expression of Bcl-xL, an antiapoptotic gene, and the activation of CPP32 during this apoptotic process. IFN-alpha as well as IL-6 prevented DEX plus alphaIGF-1R-induced apoptosis, and this prevention was blocked by the mitogen-activated protein kinase kinase inhibitor, PD098059, or the phosphatidylinositol 3-kinase inhibitor, wortmannin. Therefore, both IL-6 and IFN-alpha blocked DEX plus alphaIGF-1R-induced apoptosis through activation of the mitogen-activated protein kinase and phosphatidylinositol 3-kinase pathways.

Integrin-associated protein/CD47 regulates motile activity in human B-cell lines through CDC42

Cell migration requires a dynamic interaction between the cell, its substrate, and the cytoskeleton-associated motile apparatus. Integrin-associated protein (IAP)/CD47 is a 50-kd cell surface protein that is physically associated with beta3 integrins and that modulates the functions of beta3 integrins in various cells. However, in B-lymphocytes that express beta1 integrins but few beta3 integrins, the roles of IAP/CD47 remain to be determined. Cross-linking of IAP/CD47 by the immobilized anti-IAP/CD47 monoclonal antibody (mAb) B6H12, but not 2D3, produced signals to promote polarization with lamellipodia, a characteristic morphology during leukocyte migration, in pre-B and mature B-cell lines (BALL, Nalm6, ONHL-1, Daudi), but not in myeloma cell lines (RPMI8226, OPM-2). In the presence of the immobilized fibronectin (FN), soluble B6H12 could increase the rate of the polarization and activate migratory activity of BALL cells to FN in a transwell filter assay. Furthermore, the dominant-negative form of CDC42 completely blocked B6H12-induced morphologic and functional changes without inhibiting phorbol 12-myristate 13-acetate-induced spreading on FN in BALL cells, whereas the dominant-negative form of Rac1 inhibited all these changes. These findings demonstrate that in B-lymphocytes, IAP/CD47 may transduce the signals to activate the migratory activity, in which CDC42 may be specifically involved, and that IAP/CD47 shows synergistic effect with alpha4beta1 on B-cell migration. These findings would provide new insight into the role of IAP/CD47 on B-cell function.

Motor unit sound in needle electromyography: assessing normal and neuropathic units

Motor unit action potentials (MUPs) recorded by a monopolar needle electrode in normal and neuropathic muscles were computer-simulated. Five experienced electromyographers acted as examiners and assessed the firing sounds of these MUPs without seeing them on a display monitor. They judged whether the sounds were crisp or close enough to accept for the evaluation of MUP parameters and whether, when judged acceptable, they were neuropathic-polyphasic. The examiners recognized motor unit (MU) sound as crisp or polyphasic when the MUP obtained was 0.15-0.2 mm from the edge of the MU territory. When the intensity of the sound decreased, they were unable to perceive it as crisp. When the intensity exceeded the saturation level of loudspeaker output, the sound was perceived as polyphasic, but the wave form of the MUP was not. When the frequency of the neuropathic MUP was lowered, the examiners were unable to determine whether the MUP was polyphasic. MUPs recognized as acceptable for evaluation can be distinguished by listening to MU sounds. The audio amplifier gain must be appropriately adjusted for each MUP amplitude in order to assess whether an individual MU sound is crisp or polyphasic before MUP parameters are measured on a display monitor.

Limitin: An interferon-like cytokine that preferentially influences B-lymphocyte precursors

We have identified an interferon-like cytokine, limitin, on the basis of its ability to arrest the growth of or kill lympho-hematopoietic cells. Limitin strongly inhibited B lymphopoiesis in vitro and in vivo but had little influence on either myelopoiesis or erythropoiesis. Because limitin uses the interferon alpha/beta receptors and induces interferon regulatory factor-1, it may represent a previously unknown type I interferon prototype. However, preferential B-lineage growth inhibition and activation of Janus kinase 2 in a myelomonocytic leukemia line have not been described for previously known interferons.

Event-related potentials and thought disorder in schizophrenia

We examined the relationship between event-related potentials and thought disorder in schizophrenia. The subjects were 29 chronic schizophrenic patients. Thought disorder was assessed using the Comprehensive Index of Positive Thought Disorder developed by Harrow and colleagues (Harrow and Quinlan, 1985; Marengo et al., 1986). Auditory event-related potentials were recorded during a standard oddball task. The P300 amplitude correlated negatively with the severity of the thought disorder. The P300 amplitude in the patients with thought disorder was significantly smaller than in the patients without thought disorder. These results suggest that a reduction in P300 amplitude is associated with a fundamental impairment of information processing in schizophrenic patients.

[TTV materno-infantile infection--a study on the TTV frequency in Japanese pregnant women and the natural history of TTV mother-to-infant infection]

We preliminarily describe the frequency of TTV in Japanese pregnant women, non-parenteral, postnatal materno-infantile transmission of TTV, and 2 cases in which infantile development of the TTV carrier-state seemed to have occurred by vertical infection. The sera of 85 hepatitis B, C and G-positive and 36 non-pathological pregnant Japanese women were screened for the presence of TTV DNA with a use of semi-nested PCR. The positive rates were 25.9 and 27.8%, respectively. No significant differences were gained between these two groups. Twenty-one infants were born to the TTV carrier women. Of them, 9 infants (42.9%) sero-converted to TTV DNA-positive after their age of 4 months. Among the infants who were breast-fed, the positive sero-conversion rate of TTV DNA tended to increase as the length of the breast feeding period increased. Serum AST/ALT levels stayed within normal upper limits in the 9 infants. This study indicates the frequent, and furthermore, certain possibility of non-parenteral (i.e., via breast milk), postnatal vertical infection of TTV.

The size index as a motor unit identifier in electromyography examined by numerical calculation

A computer simulation was performed to investigate the size index as a motor unit identifier in electromyography. The size index calculated from the amplitude and area of the simulated motor unit action potential (MUP) was plotted against the distance between the needle electrode and current source to show how the index changes as a function of the distance. The index of the MUP also was plotted against the number of muscle fibers belonging to a single motor unit, the size of the motor unit territory, and the diameter of the muscle fibers in order to establish the major determinants of the index. The index was relatively constant for the distance less than 2 mm between the needle electrode and closest edge of the current source. It changed logarithmically with the number of muscle fibers and with the diameter of the fibers.

Effect of the interaction between fibronectin and VLA-4 on the proliferation of human B cells, especially a novel human B-cell line, OPM-3

Very late antigen (VLA)-4 integrin has been suggested to play an important role in haemopoiesis. However, little is known concerning the roles of the fibronectin (FN)/VLA-4 interaction in the proliferation of human B cells. In this study we investigated the effect of immobilized FN on the proliferation of various B-cell lines, including a newly-established B-cell line, OPM-3, and human tonsillar B cells, that primarily express VLA-4 but not VLA-5. Immobilized FN significantly promoted the proliferation of OPM-3 cells and normal B cells via VLA-4. The cross-linking of beta1 integrins of OPM-3 cells resulted in the phosphorylation of the focal adhesion kinase (FAK) associated 90 kD protein, an increase in FAK-associated kinase activity, and the phosphorylation of Raf-1. Furthermore, the MEK1 inhibitor, PD98059, inhibited the FN-promoted proliferation of OPM-3 cells. These results demonstrate that the FN/VLA-4 interaction transmits the growth signal(s) which may be mediated by Ras pathway in OPM-3 cells, and suggest that OPM-3 cells may be of great value in studying the roles of the FN/VLA-4 interaction in human B-cell growth.

P3a of event-related potential in chronic methamphetamine dependence

To investigate the psychophysiological features of methamphetamine (MAP) dependence, we recorded auditory event-related potentials (ERPs) in 15 patients with MAP dependence and in 15 age-matched normal controls. ERPs were recorded during a standard oddball task and a read task similar to those employed by Squires et al. (Squires NK, Squires KC, Hillyard SA [1975] Two varieties of long-latency positive waves evoked by unpredictable auditory stimuli in man. Electroenceph Clin Neurophysiol 38:387-401). The patients with MAP dependence showed reduced P3a amplitude and area in the read task and delayed P3b latency with normal P3b amplitude and area in the oddball task. These results suggest that central noradrenergic dysregulation may persist after the remission of acute psychotic symptoms in MAP psychosis and that chronic MAP dependence would produce impairment of the frontal cortex.

[Total cavopulmonary connection for grown diminutive pulmonary artery after staged Blalock-Taussig shunt]

We report a two-year-old girl with asplenia, [A, L, L] DORV, pulmonary atresia, common AV valve, PDA, and TAPVC, who successfully underwent total cavo pulmonary connection (TCPC). Deep cyanosis was pointed out since birth. Cardiac catheterization performed on the sixth day after birth revealed a diminutive pulmonary artery tree of which PA index was 41 mm2/m2. Left modified Blalock-Taussig shunt was created at 27 days of age. The PA index increased to 282 mm2/mm2, but disparity in diameter between the left and the right pulmonary artery was yielded by PDA subsidence. Therefore additional contralateral B-T shunt was made at one year of age. Follow-up cardiac catheterization at 28 months of age showed well developed pulmonary artery; PA index of 460 mm2/m2, right pulmonary resistance (Rp) of 3.49 units, left Rp of 2.33 units, and estimated total Rp was 1.39. According to study, bidirectional Glenn procedure or TCPC was indicated. Considering necessity of urgent repair of common pulmonary vein obstruction, regurgitation of the common atrio-ventricular valve and pulmonary artery stenosis, TCPC was performed with concomitant repair of the associated lesions. Severe butterfly-figure stenosis of the central PA was augmented by anastomosing both the left SVC and the left-sided atrium. In conclusion, diminutive pulmonary artery could be adequately grown by phase-in Blalock-Taussig shunts. Pulmonary blood flow scintigraphy was thought to be useful for estimation of pulmonary resistance in such cases with different pulmonary resistance between right and left PA.

Decreased nitric oxide-mediated natural killer cell activation in chronic fatigue syndrome

BACKGROUND

L-Arginine (L-Arg), one of the essential amino acids, has been reported to have an immunomodulatory effect. The precise mechanism of the L-Arg-induced natural killer (NK) cell activation remains unresolved,and the effect of L-Arg on NK cells in chronic fatigue syndrome (CFS) patients has not been estimated.

METHODS

NK cell function was evaluated in 20 subjects with CFS and compared with that in 21 healthy individuals.

RESULTS

In healthy control subjects, NK activity was significantly increased after treatment with L-Arg, an NK function enhancer, for 24 h, whereas the same treatment failed to enhance NK activity in the CFS patients. We thus focused on L-Arg metabolism, which involves nitric oxide (NO) production through NO synthase (NOS). The expression of inducible NO synthase (iNOS) transcripts in peripheral blood mononuclear cells was not significantly different between healthy control subjects and CFS patients. The L-Arg-mediated NK cell activation was abolished by addition of NG-monomethyl-L-arginine, an inhibitor for iNOS. Furthermore, incubation with S-nitroso-N-acetyl-penicillamine, an NO donor, stimulated NK activity in healthy control subjects but not in CFS patients.

CONCLUSION

These results demonstrate that the L-Arg-induced activation of NK activity is mediated by NO and that a possible dysfunction exists in the NO-mediated NK cell activation in CFS patients.

Insulin-like growth factor-I augments erythropoietin-induced proliferation through enhanced tyrosine phosphorylation of STAT5

Insulin-like growth factor (IGF-I) is known to synergistically stimulate the proliferation of hematopoietic cells in combination with other hematopoietic growth factors. However, the precise mechanism underlying the cooperative effects of IGF-I is unknown. In a human interleukin-3 or erythropoietin (EPO)-dependent cell line, F-36P, IGF-I alone failed to stimulate DNA synthesis but did augment the EPO-dependent DNA synthesis of F-36P cells. The treatment of F-36P cells with a combination of EPO and IGF-I (EPO/IGF-I) was found to enhance EPO-induced tyrosine phosphorylation of STAT5, whereas IGF-I alone did not. Furthermore, c-CIS mRNA expression, one of the target molecules of STAT5, was more effectively induced by EPO/IGF-I than by EPO alone. To examine the mechanisms of the EPO- and EPO/IGF-I-induced proliferation of F-36P cells, we expressed dominant negative (dn) mutants of STAT5 and Ras in an inducible system. The EPO-induced DNA synthesis and the cooperative effect of EPO/IGF-I were significantly inhibited by the inducible expression of dn-STAT5 or dn-Ras. In addition, the inducible expression of dn-Ras abolished the IGF-I-enhanced tyrosine phosphorylation of STAT5. These results suggest that IGF-I may augment EPO-induced proliferation by enhancing tyrosine phosphorylation of STAT5 and raise the possibility that Ras may be involved in the augmentation of STAT5 tyrosyl phosphorylation.

[A surgical case of supravalvular aortic stenosis with severe hypoplastic ascending aorta (diffuse type) in Williams-Beuren syndrome]

We report a six-year-old boy who underwent ascending aortic reconstruction for supravalvular aortic stenosis of diffuse type associated with Williams-Beuren syndrome. The diagnosis was first made at the age of six months. Because of progressive left ventricular hypertrophy, cardiac catheterization was performed at the age of five years and showed left ventricular pressure of 200 mmHg, the ascending aortic pressure of 202 mmHg, the descending aortic pressure of 115 mmHg, and left ventricular end-diastolic volume of 33.5 ml (90% of normal). Whole ascending aorta except sinus Valsalva was severely hypoplastic, so called diffuse type of supravalvular aortic stenosis. The ascending aorta was only 6.3 mm in diameter, whereas the diameter of the aortic annulus was 20.6 mm. The ascending aortic reconstruction of Doty's type was performed from the aortic root to the distal aortic arch with a equine pericardium reinforced by Dacron velour using selective perfusion to the right bracheocepharic artery, the left common carotid artery and the right femoral artery to avoid circulatory arrest. Postoperative course was uneventful and post operative catheterization revealed left ventricular pressure of 128 mmHg, the ascending aortic pressure of 126 mmHg and the descending aortic pressure of 90 mmHg. Mild residual pressure gradient was probably due to hypoplastic descending aorta. In conclusion, patch aortic reconstruction for ascending aorta under selective cerebral perfusion for a six-year old boy can be performed without postoperative neurological complication.

[Color M-mode Doppler analysis of left ventricular inflow in pediatric patients]

This study evaluated the clinical usefulness of analyzing left ventricular (LV) filling by color M-mode Doppler echocardiography in pediatric patients. The LV-filling patterns of color M-mode Doppler echocardiography were obtained by LV inflow in the apical 4-chamber or long-axis view, and the time difference between the occurrence of peak velocity at the mitral tip and in the apical region (M-AP) was calculated. The peak velocity at each depth was determined by adequate selection of the Nyquist limit by shifting the zero point after freezing the color M-mode. LV volume and posterior wall motion velocity were obtained simultaneously. The catheter-derived data were compared with echo-derived data in 7 patients (mean age 12.0 years). The M-AP correlated positively with the time constant of LV relaxation (tau; r = 0.83, p < 0.05), pulmonary capillary wedge pressure (r = 0.83, p < 0.05), and negatively with peak diastolic posterior wall motion velocity (r = -0.78, p < 0.05). The M-AP was compared with other echo-derived data between Group N (35 children with normal cardiac function, mean age 4.3 years) and Group F (12 children with LV ejection fraction less than 40%, mean age 9.5 years). The M-AP was significantly longer in Group F (53.3 +/- 14.0 vs 116.5 +/- 30.5 msec; p < 0.001), but there was no significant difference in the E/A or deceleration time of E between the 2 groups. In Group N, the E/A correlated to LV end-diastolic volume and heart rate, but the M-AP showed no correlation. In Group F, the M-AP correlated with the percentages of normal LV end-diastolic volume (r = 0.76, p < 0.01) and LV ejection fraction (r = -0.58, p < 0.05). The M-AP was not influenced by LV size or heart rate and could easily differentiate normal heart from failing heart, and thus this is a useful parameter for evaluating diastolic function in pediatric patients.

[Remarkable increase of CD8+ CD11a+ and CD8+ CD57- T cells in patients with post-transfusion graft-versus-host disease]

We analyzed the distribution of two T cell subsets, CD8+ CD11a+ (CD8+ cytotoxic effector population) and CD8+ CD57- cells, in the peripheral lymphocytes of 3 post-operative patients with post-transfusion graft-versus-host disease (PT-GVHD) and 5 post-operative patients without PT-GVHD. The percentage of CD8+ CD11a+ cells in the PT-GVHD-negative control was 19 +/- 4%, and in the 3 patients with PT-GVHD, 69%, 66%, and 59%, respectively. The percentage of CD8+ CD57- cells in the PT-GVHD-negative control was 19 +/- 6%, and in the 3 PT-GVHD patients, 59%, 58%, and 55%, respectively. Significantly higher proportions of the two T cell subsets were consistently observed in the patients with PT-GVHD than in the PT-GVHD-negative control. These results suggest that the analysis of CD8+ T cell subsets may be useful for the simple and rapid laboratory diagnosis of PT-GVHD.

A follow up study of myocardial involvement in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS)

OBJECTIVE

To investigate cardiac function in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) and clarify the clinical features of cardiomyopathy in MELAS.

PATIENTS

11 consecutive patients with MELAS (mean age at initial examination 11.3 years, range 4 to 16 years) were enrolled in the study. Six were followed for more than five years.

RESULTS

On echocardiographic examination, three patients showed increased left ventricular end diastolic posterior wall thickness (LVPWTd), exceeding 140% of the normal value. Four patients, including these three, had an ejection fraction of less than 50%, and two also had increased left ventricular end diastolic volume (LVEDV) exceeding 140% of the normal value (%N). The LVPWTd%N was correlated positively with the LVEDV%N (R = 0.669, p < 0.05) and negatively with the ejection fraction (R = -0.6701, p < 0.05). One patient died of heart failure aged 22 years.

CONCLUSIONS

The cardiomyopathy in MELAS is characterised by an abnormally thick left ventricular wall with progressive dilatation and poor left ventricular contraction developing over several years, indicating hypertrophic cardiomyopathy advancing to dilated cardiomyopathy.

Relationship between nerve and muscle fiber conduction velocities of the same motor unit in man

To test the hypothesis that the nerve fiber conduction velocity of a motor unit is correlated with the muscle fiber conduction velocity of the unit, the collision technique was used to discriminate the motor unit action potentials elicited by stimulation of a group of nerve fibers with known conduction velocity. Muscle fiber conduction velocity was determined from the propagating action potentials of the unit recorded by a surface electrode array. A weak but significantly positive correlation was found between nerve and muscle fiber conduction velocities in the thenar muscle of human subjects. The results indicate that the size principle that governs the relation between nerve and muscle fiber size is a fairly weak principle with occasional exceptions.

Bisecting GlcNAc structure is implicated in suppression of stroma-dependent haemopoiesis in transgenic mice expressing N-acetylglucosaminyltransferase III

Several sugar structures have been reported to be necessary for haemopoiesis. We analysed the haematological phenotypes of transgenic mice expressing beta-1,4 N-acetylglucosaminyltransferase III (GnT-III), which forms bisecting N-acetylglucosamine on asparagine-linked oligosaccharides. In the transgenic mice, the GnT-III activity was elevated in bone marrow, spleen and peripheral blood and in isolated mononuclear cells from these tissues, whereas no activity was found in these tissues of wild-type mice. Stromal cells after long-term cultures of transgenic-derived bone marrow and spleen cells also showed elevated GnT-III activity, compared with an undetectable activity in wild-type stromal cells. As judged by HPLC analysis, lectin blotting and lectin cytotoxicity assay, bisecting GlcNAc residues were increased on both blood cells and stromal cells from bone marrow and spleen in transgenic mice. The transgenic mice displayed spleen atrophy, hypocellular bone marrow and pancytopenia. Bone marrow cells and spleen cells from transgenic mice produced fewer haemopoietic colonies. After lethal irradiation followed by bone marrow transplantation, transgenic recipient mice showed pancytopenia compared with wild-type recipient mice. Bone marrow cells from transgenic donors gave haematological reconstitution at the same level as wild-type donor cells. In addition, non-adherent cell production was decreased in long-term bone marrow cell cultures of transgenic mice. Collectively these results indicate that the stroma-supported haemopoiesis is compromised in transgenic mice expressing GnT-III, providing the first demonstration that the N-glycans have some significant roles in stroma-dependent haemopoiesis.

Vertical transmission of hepatitis C virus: risk factors and infantile prognosis

OBJECTIVES

To clarify the incidence and risk factors of the vertical transmission of hepatitis C virus (HCV) and to determine the prognosis of the carrier infants.

METHODS

At our hospital, 1,941 non-pathological (non-HIV carriers) Japanese pregnant women were screened for anti-HCV antibodies. Sera of the antibody-positive women were examined by the reverse transcription polymerase chain reaction (RT-PCR) method, and the positive women and their infants were followed by testing HCV-related markers.

RESULTS

The HCV carrier rate among the pregnant women was 3.5% (68/1,941). Four among the 65 infants (6.2%) who were successfully followed for more than 6 months developed the HCV carrier-state. Of all the risk factors examined, only the elevation (> or = 110 IU/l) of maternal serum alanine aminotransferase (ALT) was found to be significant for HCV vertical transmission. Seventy-five and 50% of the carrier infants manifested chemical hepatitis and seroconverted to an HCV-RNA-negative status, respectively, during the follow-up period.

CONCLUSIONS

The frequency of HCV vertical transmission was 6.2%. Half of the carrier infants became seronegative for HCV-RNA. HCV vertical transmission was significantly affected by the maternal serum ALT level prior to delivery.

Event-related potentials during a selective attention task with short interstimulus intervals in patients with schizophrenia

OBJECTIVE

To study selective attention in schizophrenia by examining event-related potentials during a dichotic listening task with short interstimulus intervals (ISIs).

DESIGN

Prospective study.

PARTICIPANTS

Twelve patients with schizophrenia in remission and 12 age-matched controls with no history of psychiatric or neurological illness.

INTERVENTIONS

Participants were asked to push a button in response to target stimuli in either ear.

OUTCOME MEASURES

Reaction time, correct response rate and results of electroencephalography recorded at 3 regions: mean segmental amplitudes between 0 and 200 ms and between 200 and 400 ms after stimuli and processing negativity (Nd), measured by the negative area during these periods.

RESULTS

Distinct slow-positive potentials for unattended stimuli, which were elicited in a task with long ISIs in a previous report, did not emerge in either group in this study. Although the 2 groups did not differ significantly in terms of Nd area, in the controls the mean segmental amplitude for attended standard stimuli was significantly greater than that in the patients with schizophrenia.

CONCLUSIONS

Impairment of selective attention in patients with schizophrenia is related to a lack of ability to focus attention on attended task-relevant stimuli during a selective attention task with short ISI.