High-Fat Diet-Induced Diabetic Conditions Exacerbate Cognitive Impairment in a Mouse Model of Alzheimer's Disease Via a Specific Tau Phosphorylation Pattern

BACKGROUND

Epidemiological evidence has demonstrated a clear association between diabetes mellitus and increased risk of Alzheimer's disease (AD). Cerebral accumulation of phosphorylated tau aggregates, a cardinal neuropathological feature of AD, is associated with neurodegeneration and cognitive decline. Clinical and experimental studies indicate that diabetes mellitus affects the development of tau pathology; however, the underlying molecular mechanisms remain unknown.

OBJECTIVE

In the present study, we used a unique diabetic AD mouse model to investigate the changes in tau phosphorylation patterns occurring in the diabetic brain.

DESIGN

Tau-transgenic mice were fed a high-fat diet (n = 24) to model diabetes mellitus. These mice developed prominent obesity, severe insulin resistance, and mild hyperglycemia, which led to early-onset neurodegeneration and behavioral impairment associated with the accumulation of hyperphosphorylated tau aggregates.

RESULTS

Comprehensive phosphoproteomic analysis revealed a unique tau phosphorylation signature in the brains of mice with diabetic AD. Bioinformatic analysis of the phosphoproteomics data revealed putative tau-related kinases and cell signaling pathways involved in the interaction between diabetes mellitus and AD.

CONCLUSION

These findings offer potential novel targets that can be used to develop tau-based therapies and biomarkers for use in AD.

Prenatal clinical manifestations in individuals with COL4A1/2 variants

BACKGROUND

Variants in the type IV collagen gene (COL4A1/2) cause early-onset cerebrovascular diseases. Most individuals are diagnosed postnatally, and the prenatal features of individuals with COL4A1/2 variants remain unclear.

METHODS

We examined COL4A1/2 in 218 individuals with suspected COL4A1/2-related brain defects. Among those arising from COL4A1/2 variants, we focused on individuals showing prenatal abnormal ultrasound findings and validated their prenatal and postnatal clinical features in detail.

RESULTS

Pathogenic COL4A1/2 variants were detected in 56 individuals (n=56/218, 25.7%) showing porencephaly (n=29), schizencephaly (n=12) and others (n=15). Thirty-four variants occurred de novo (n=34/56, 60.7%). Foetal information was available in 47 of 56 individuals, 32 of whom (n=32/47, 68.1%) had one or more foetal abnormalities. The median gestational age at the detection of initial prenatal abnormal features was 31 weeks of gestation. Only 14 individuals had specific prenatal findings that were strongly suggestive of features associated with COL4A1/2 variants. Foetal ventriculomegaly was the most common initial feature (n=20/32, 62.5%). Posterior fossa abnormalities, including Dandy-Walker malformation, were observed prenatally in four individuals. Regarding extrabrain features, foetal growth restriction was present in 16 individuals, including eight individuals with comorbid ventriculomegaly.

CONCLUSIONS

Prenatal observation of ventriculomegaly with comorbid foetal growth restriction should prompt a thorough ultrasound examination and COL4A1/2 gene testing should be considered when pathogenic variants are strongly suspected.

An infant with refractory cytomegalovirus-induced thrombocytopenia

The present case underscores the importance of considering the association of severe thrombocytopenia or immune thrombocytopenia with cytomegalovirus (CMV) infection because CMV-induced thrombocytopenia occasionally requires antiviral therapy.

Combination of furosemide and fludrocortisone as a loading test for diagnosis of distal renal tubular acidosis in a pediatric case

Renal tubular acidosis (RTA) is a rare disease caused by a defect of urinary acidification. The ammonium chloride loading test is the gold standard method for determining the type of RTA. However, because this test has some side effects (e.g., nausea, vomiting, and stomach discomfort), applying this test for pediatric cases is difficult. Recently, a loading test with the combination of furosemide and fludrocortisone was reported to be an alternative to the ammonium chloride loading test, with 100% sensitivity and specificity in adult's cases. We report the first pediatric case of distal RTA in a patient who was successfully diagnosed by a drug loading test with the combination of furosemide and fludrocortisone without any side effects. We also performed genetic analysis and detected a known pathogenic variant in the SLC4A1 gene. The combination loading test of furosemide and fludrocortisone is a useful and safe diagnostic tool for pediatric cases of RTA.

A Japanese case of mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency who presented with severe metabolic acidosis and fatty liver without hypoglycemia

Mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency (mHS deficiency) is a rare autosomal recessive inborn error of ketogenesis caused by a mutation in the HMGCS2 gene, which is characterized by non-(hypo)-ketotic hypoglycemia, lethargy, and hepatomegaly during acute infection and/or prolonged fasting. Clinical presentations are similar to fatty acid oxidation defects; however, diagnosis of mHS deficiency is difficult because of poor biochemical markers. We report the case of a 12-month-old Japanese boy with mHS deficiency who presented with a coma, and hepatomegaly, but no hypoglycemia after a febrile episode and poor oral intake. Metabolic acidosis and severe fatty liver were observed. Serum acylcarnitine analysis revealed a slightly decreased free carnitine (C0) level and an increased acetylcarnitine (C2) level. Urinary organic acid analysis revealed hypoketotic dicarboxylic aciduria, and increased excretions of glutarate, and, retrospectively, 4-hydroxy-6-methyl-2-pyrone. Although the patient did not present with hypoglycemia, the severe fatty liver and elevated free fatty acids to total ketone bodies ratio strongly suggested an inborn error of ketogenesis. In the analysis of the HMGCS2 gene, compound heterozygous mutations of c.130_131ins C (L44PfsX29) and c.1156_1157insC (L386PfsX73) were identified, which led to the diagnosis of mHS deficiency. He had recovered without any complication by the therapy, including intravenous glucose infusion. Unlike the previously reported cases of mHS deficiency, our case did not present with hypoglycemia and the fatty liver lasted over several months. mHS deficiency should be taken into consideration when a patient has severe metabolic acidosis and fatty liver with no or subtle ketosis, even without hypoglycemia.

Clinical time course of pediatric acute disseminated encephalomyelitis

The detailed clinical time course in acute disseminated encephalomyelitis (ADEM) from initial symptoms, through exacerbation, to remission has not been widely reported. Hence, this study aimed to investigate the clinical time course of pediatric ADEM. This was a multicenter retrospective study based on registry data from medical chart reviews. The study included children who met the international consensus diagnostic criteria for ADEM. The patients comprised 18 boys and 6 girls, with a mean age of 5.5 ± 3.3 years at onset. From onset, the time until peak neurological symptoms, time until initial improvement, and time until full recovery was 3.1 ± 3.7 days, 6.0 ± 4.5 days, and 26 ± 34 days, respectively. Twenty-three (96%) patients were treated with high-dose methylprednisolone (mPSL) with a mean duration of 4.1 ± 4.0 days from onset. The condition of 15 patients (65%) improved within 3 days of high-dose mPSL initiation, whereas, that of four patients began to improve after >5 days of high-dose mPSL initiation. Only one patient (4%) did not achieve full recovery despite treatment with high-dose mPSL, intravenous immunoglobulin, and plasma exchange. This study presents the detailed clinical time course in pediatric ADEM in Japan. Progression of neurologic deficits typically lasts a few days, with initial improvement in 1 week leading to full recovery within 1 month.

Lipid and thyroid hormone levels in children with epilepsy treated with levetiracetam or carbamazepine: A prospective observational study

Although previous studies have investigated the influence of antiepileptic drugs (AEDs) on lipid profiles and thyroid hormone levels, there is little evidence regarding the effects of levetiracetam (LEV). Therefore, we conducted a prospective longitudinal study to evaluate the effects of LEV and carbamazepine (CBZ) treatment on lipid profile and thyroid hormone levels in patients newly diagnosed with epilepsy. Inclusion criteria were as follows: (a) age between 4 and 15 years, (b) diagnosis of epilepsy with at least two focal seizures within a year, and (c) newly treated with LEV or CBZ monotherapy. Serum lipid profile and thyroid hormone levels were measured before and after 1 and 6 months of AED initiation. Among the 21 included patients (LEV: 13 patients, CBZ: 8 patients), all but one patient in the LEV group continued AED monotherapy during the study period. Although triglyceride (TG) levels tended to be increased in the CBZ group (baseline: 58.3 ± 22.0 mg/dl, 1 month: 63.8 ± 21.6 mg/dl, 6 months: 92.3 ± 63.6 mg/dl, p = 0.22, analyses of variance (ANOVA)), there were no significant changes in total cholesterol (TC), TG levels, high-density lipoprotein cholesterol (HDL-C), or low-density lipoprotein cholesterol (LDL-C) in either group. Serum free thyroxine (fT4) levels were significantly decreased in the CBZ group (baseline: 1.15 ± 0.06 ng/dl, 1 month: 1.00 ± 0.16 ng/dl, 6 months: 0.98 ± 0.14 ng/dl, p = 0.03, ANOVA). In contrast, there were no significant changes in fT4 or thyroid-stimulating hormone (TSH) levels in the LEV group. The results of the present study suggest that LEV monotherapy does not affect lipid profile or thyroid function while CBZ monotherapy may cause thyroid dysfunction.

A Pivot Bearing-Supported Centrifugal Pump for a Long-Term Assist Heart

A pivot bearing-supported centrifugal blood pump has been developed. It is a compact, cost effective, and anti-thrombogenic pump with anatomical compatibility. A preliminary evaluation of five paracorporeal left ventricular assist studies were performed on pre-conditioned bovine (70-100 kg), without cardiopulmonary bypass and aortic cross-clamping. The inflow cannula was inserted into the left ventricle (LV) through the apex and the outflow cannula affixed with a Dacron vascular graft was anastomosed to the descending aorta. All pumps demonstrated trouble free performance over a two-week screening period. Among these five studies, three implantations were subjected for one month system validation studies. All the devices were trouble free for longer than 1 month. (35, 34, and 31 days). After achieving one month studies, all experiments were terminated. There was no evidence of device induced thrombus formation inside the pump. The plasma free hemoglobin levels were within normal ranges throughout all experiments. As a consequence of these studies, a mass production model C1E3 of this pump was fabricated as a short-term assist pump. This pump has a Normalized Index of Hemolysis of 0.0007 mg/100L and the estimated wear life of the impeller bearings is longer than 8 years. The C1E3 will meet the clinical requirements as a cardiopulmonary bypass pump. For the next step, a miniaturized pivot bearing centrifugal blood pump PI-601 has been developed for use as a permanently implantable device after design optimization. The evolution from C1E3 to the PI-601 converts this pivot bearing centrifugal pump as a totally implantable centrifugal pump. A pivot bearing centrifugal pump will become an ideal assist pump for the patients with failing heart.

Clinical prediction rule for neurological sequelae due to acute encephalopathy: a medical community-based validation study in Harima, Japan

OBJECTIVES

This study aimed to verify the screening performance of our clinical prediction rule for neurological sequelae due to acute encephalopathy (NSAE-CPR), which previously identified the following three variables as predictive of poor outcomes: (1) refractory status epilepticus; (2) consciousness disturbance and/or hemiplegia at 6 hours from onset and (3) aspartate aminotransferase >90 IU/L within 6 hours of onset.

DESIGN

Medical community-based multicentre retrospective cohort study.

SETTING

Six regional hospitals in Harima and one tertiary centre in Kobe, Japan, from 2008 to 2012.

PARTICIPANTS

We enrolled a total of 1612 patients aged <16 years who met the diagnostic criteria for an initial diagnosis of complex febrile seizure. Patients with a history of neurological disease and those included in the derivation cohort were excluded.

PRIMARY OUTCOME MEASURES

Univariate and multivariate analyses were performed to determine the association between each of the three predictor variables and poor AE outcome (Pediatric Cerebral Performance Category score ≥2). Receiver operating characteristic curve (ROC) analysis was also performed to assess the screening performance of the NSAE-CPR.

RESULTS

The ROC analysis identified at least one of the three predictive variables as an optimal cut-off point, with an area under the curve of 0.915 (95% CI 0.825 to 1.000). The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and Matthews correlation coefficient were 0.867, 0.954, 0.149, 0.999, 18.704, 0.140 and 0.349, respectively.

CONCLUSIONS

Our findings indicate that the NSAE-CPR can be used for the screening and identification of patients with poor outcomes due to acute encephalopathy within 6 hours of onset.

Rituximab treatment for relapsed opsoclonus-myoclonus syndrome

INTRODUCTION

Opsoclonus-myoclonus syndrome (OMS) is a rare neurological disorder that is associated with paraneoplastic diseases. Because OMS can frequently relapse, patients may be inflicted with neurological problems for a long time. Recently, rituximab (RTX) was introduced as a drug to treat OMS. To assess RTX treatment, we studied a patient who experienced recurrence of OMS.

CASE REPORT

A 2-year-old Japanese boy, who had left adrenal neuroblastoma, suddenly showed OMS symptoms, including ataxia and opsoclonus. Surgical resection of the tumor and subsequent steroid therapy ameliorated his symptoms. When OMS relapsed during the time when prednisolone was reduced, he was treated with full-dose RTX therapy (375 mg/m2/week) for 4 consecutive weeks. However, 1year later, he presented again with OMS symptoms. This time, we only administered an additional single dose of RTX treatment (375 mg/m2), allowing remission of OMS symptoms. During 2 years after the additional RTX treatment, OMS symptoms did not appear, even when prednisolone was reduced. He had no adverse events associated with RTX during the whole treatment period.

CONCLUSIONS

An additional single-dose RTX therapy might be effective for relapsed OMS patients who were previously treated with full-dose RTX therapy.

[Risk of seizure recurrence after a first unprovoked seizure in childhood]

OBJECTIVE

To assess the risk of recurrence after a first unprovoked seizure in childhood.

METHODS

This was a prospective study of 250 children aged 1 month to 16 years after a first seizure who presented between November 1, 2008 and October 31, 2012. None of the children was treated after the first seizure. Recurrence rates were calculated by Kaplan-Meier survival analysis, and univariate analyses for recurrence risk were performed using the Cox proportional hazards model.

RESULTS

One hundred and thirty-five children (54%) had recurrence. Thirty-seven (27%) of the recurrences occurred in the first month, 71 (53%) within 3 months, 95 (70%) within 6 months, and 118 (87%) within 1 year. The risk of seizure recurrence was 38%, 47%, 54%, and 58% at 0.5, 1, 2, and 5 years, respectively. The risk factors for seizure recurrence were remote symptomatic etiology, abnormal electroencephalography, age ≥ 8 years, and a history of prior febrile seizure (partial seizure).

CONCLUSIONS

Children should not be routinely treated after a first seizure, and it is important that we consider the recurrence rate and risk.

Apomictic parthenogenesis in a parasitoid wasp Meteorus pulchricornis, uncommon in the haplodiploid order Hymenoptera

Although apomixis is the most common form of parthenogenesis in diplodiploid arthropods, it is uncommon in the haplodiploid insect order Hymenoptera. We found a new type of spontaneous apomixis in the Hymenoptera, completely lacking meiosis and the expulsion of polar bodies in egg maturation division, on the thelytokous strain of a parasitoid wasp Meteorus pulchricornis (Wesmael) (Braconidae, Euphorinae) on pest lepidopteran larvae Spodoptera litura (Fabricius) (Noctuidae). The absence of the meiotic process was consistent with a non-segregation pattern in the offspring of heterozygous females, and no positive evidence was obtained for the induction of thelytoky by any bacterial symbionts. We discuss the conditions that enable the occurrence of such rare cases of apomictic thelytoky in the Hymenoptera, suggesting the significance of fixed heterosis caused by hybridization or polyploidization, symbiosis with bacterial agents, and occasional sex. Our finding will encourage further genetic studies on parasitoid wasps to use asexual lines more wisely for biological control.

Treatment of preterm infants with West syndrome: differences due to etiology

BACKGROUND

This study was conducted with a particular focus on preterm infants with West syndrome (WS) to evaluate differences in the first responses to oral medication based on etiology.

METHODS

Medical records of 53 patients with WS, treated at five institutions between 2005 and 2009, were reviewed retrospectively. Patients were divided into six groups based on the time of brain insult, and evaluated for short-term outcomes using oral anti-epileptic agents and synthetic adrenocorticotropic hormone.

RESULTS

The sample consisted of 15, six, 14, two, four, and 12 patients classified, on the basis of apparent time of acquisition of etiology, into the prenatal, term, preterm, postnatal, other, and no identified etiology groups, respectively. Average age of onset in the term group was 3.3 ± 1.0 months, significantly earlier than in the prenatal, preterm, postnatal and no identified etiology groups (P < 0.05). All patients in the term group had experienced seizures before the onset of WS. Only patients in the preterm group had only experienced neonatal seizures, and responded better to treatment. Patients in the preterm group had better responses to treatment, especially oral medication, compared with those in the prenatal and term groups. The prevalence of relapse of seizures in the preterm group (14%) was significantly lower than that in the prenatal group.

CONCLUSIONS

Preterm WS patients responded well to treatment. Distinguishing WS patients on the basis of different etiologies is important for evaluating the effectiveness of treatment.

[Intravenous injection of phenobarbital for benign convulsions with mild gastroenteritis]

OBJECTIVE

We investigated the effectiveness of intravenous injection of phenobarbital (PB) in patients referred to Himeji Red Cross Hospital, Hyogo, Japan, with benign convulsions with mild gastroenteritis (CwG) between November 2009 and June 2011.

METHODS

The patients who had a single seizure at the time of consultation were, in principle, followed without any treatment, and those with repeated seizures were treated with intravenous injection of 10 mg/kg PB.

RESULTS

During the study, 24 of 33 patients with CwG were administered PB intravenously. PB was administered after a single seizure in one patient, and the remainder were treated after 2-7 seizures, no patient had repeated seizures. The side effects were temporary and mild, although somnolence was seen in five patients, and two also showed staggering.

CONCLUSIONS

It was considered that intravenous injection of PB was effective for CwG. Intravenous injection of PB should be given to patients with CwG, regardless of whether they have vomiting and diarrhea.

Development and evaluation of 'disaster preparedness' educational programme for pregnant women

PURPOSE

The objective of this study is the development and evaluation of the usability of an educational programme that teaches disaster preparedness to pregnant women.

METHODS

This intervention study examined an intervention group that attended an educational programme and a control group that did not. The subjects were pregnant women in their second trimester. The programme was developed with prior studies and evaluated by self-administered questionnaires that asked about disaster preparedness. The questionnaire was administered twice to the participants in both groups: to the intervention group just before the childbirth class and 1 month after the class, and to the control group at the time of their maternity examination and 1 month afterwards. Two hundred twenty-six members of the intervention group and 262 members of the control group responded to both questionnaires. Of these, 99 of the intervention group and 104 of the control group were primiparous without disaster experience, and the programme was evaluated by comparing these two groups. Effects due to the disaster experience were also analysed within the intervention group.

RESULTS

Among primiparous without disaster experience, an intervention effect was found in items concerning awareness modification (five of six items) and behaviour modification (three of seven items). The intervention effect was particularly pronounced in a comparison of primiparous without disaster experience.

CONCLUSIONS

An intervention effect was found among the pregnant women who took the programme. In particular, it was statistically significant among primiparous without disaster experience, which suggests that the programme should be shaped to reflect this subject demographic.

High incidence of electrocardiogram abnormalities in young patients with duchenne muscular dystrophy

Electrocardiogram abnormalities are reported to be complicated in Duchenne muscular dystrophy. Although Duchenne muscular dystrophy can be genetically diagnosed in young patients, extensive electrocardiogram studies have not been reported. Here, electrocardiogram abnormalities were examined in Duchenne muscular dystrophy cases with dystrophin gene mutations. Sixty-nine patients, aged </=18 years, received 136 electrocardiogram examinations. Sixty-four patients (91.3%) displayed one or more abnormalities. Furthermore, patients adolescent <10 years (84.8% of patients) displayed electrocardiogram abnormalities, and the most common abnormality was deep Q-waves. Remarkably, the abnormality incidence of both deep Q-waves and low RV5 + SV1 (R-wave V5 + S-wave V1) were significantly high in adolescent patients. Although the patterns or positions of dystrophin gene mutations were compared with electrocardiogram abnormalities, no predisposing mutation was disclosed. These results indicate that electrocardiogram abnormalities in Duchenne muscular dystrophy are a result of dystrophin deficiency, regardless of types of gene mutations. The disease can be divided into two types: age-dependent and age-independent. Deep Q-waves and low RV5 + SV1 are proposed as markers of age-dependent cardiac complications.

Evaluation of the Wear of the Pivot Bearing in the Gyro C1E3 Pump

To estimate the lifetime of the pivot bearing system of the sealless centrifugal Gyro C1E3 pump, pivot bearing wear phenomena of the C1E3 were studied. The pivot bearing system consisted of a male and female pivot made of ceramics and ultrahigh molecular weight polyethylene (UHMWPE), respectively. First, many pumping tests were performed with the C1E3 under various pumping conditions, and the effects of impeller position and fluid on wear were analyzed. Through these preliminary tests, it was found that the wear progress of the pivot bearing consisted of initial wear and stationary wear. Most of this initial wear is caused by the plastic deformation of the polyethylene female pivot. It also was observed that bovine blood was almost comparable to water in its effect on the stationary wear rate at the same rotational speed. Based on these results, a long-term pumping test was performed with the C1E3, and initial and stationary wear rates were determined. At the same time, the maximal loosening distance (LDmax) (permissible total wear) of the C1E3 was determined experimentally from hemolytic and hydraulic performance perspectives. By using experimentally determined parameters the lifetime of the pivot bearing system of the C1E3 pump was estimated for various pumping conditions. The lifetime of the pivot bearing system of the C1E3 was typically 10 years for right ventricular assist, 8 years for left ventricular assist, and 5 years for cardiopulmonary bypass.

[Acute pulmonary embolism after colorectal surgery]

A 84-year-old woman presented with abdominal pain and tarry stools. She was admitted to our hospital, and colonofiberscopy showed type II tumor located cecum. We prevented deep vein thrombosis and acute pulmonary embolism (APE) after abdominal surgery by using the elastic stockings and intermittent pneumatic compression system in operation room. She underwent ileocecal resection and lymphonodi dissection (D2). On 2nd postoperative day, she complained of sudden respiratory distress with loss of consciousness and went into the state of shock. We made the diagnosis of APE after reviewing chest computed tomography and cardiac echo. An emergency atrial and pulmonary thromboembolectomy under cardiopulmonary bypass was performed. We removed the thrombus from right atrium and bilateral main pulmonary artery. After operation, we inserted a temporary vena cava filter into vena cava. We performed the anticoagulant therapy by continuous infusion of heparin with assisting respiration by respirator. The pulmonary artery pressure became steady about 25 approximately 30 mmHg. On 14th postoperative day, we extubated tracheotube. On 40th postoperative day, she could discharge from hospital on foot. Early diagnosis and prompt treatment for APE are important, and we should always keep APE in mind after abdominal surgery.

[Tricuspid valve plasty associated with removal of an infected pacemaker lead: report of a case]

We performed tricuspid valve plasty in a 72-year-old woman with pacemaker lead infection and septicemia. All the infected pacemaker system was removed under cardiopulmonary bypass. Because of advanced adhesion and infection, we needed partial resection and plasty of the tricuspid valve. Postoperative echocardiography revealed only mild tricuspid regurgitation and the recurrence of infection has been avoided. Our technique of valve plasty was useful in a patient with advanced infection of both pacemaker leads and tricuspid valve leaflets.

Rapid diversification of male genitalia and mating strategies in Ohomopterus ground beetles

We analysed evolutionary diversification and covariation in male genitalia and four mating traits related to sexual selection, i.e. testis size, spermatophore size, copulation duration and post-copulatory guarding duration, in Ohomopterus ground beetles using phylogenetically independent contrasts. Male genital size and mating duration have evolved more rapidly than body size and the other traits studied. Male genital size was negatively correlated with copulation duration, suggesting that elongated male genitalia may enable decreased time investment in a single copulation because it is more effective at facilitating spermatophore deposition. Male genital size was positively correlated with spermatophore size, suggesting coevolution between offensive and defensive male mating tactics because the elongated male genitalia may be advantageous in displacement of rivals' plug-like spermatophores, and decreased mating duration may intensify sperm competition. Thus, the remarkable diversity of male genitalia in Ohomopterus may have been facilitated by the interplay between inter- and intrasexual selection processes.

The genetic basis of interspecific differences in genital morphology of closely related carabid beetles

Marked diversification of genital morphology is common in internally fertilizing animals. Although sexual selection may be the primary process controlling genital evolution, factors promoting genital evolution are controversial, and the genetic background of genital morphology is poorly understood. We analyzed the genetic basis of species-specific genital morphologies in carabid beetles of the subgenus Ohomopterus (genus Carabus, Carabidae) using two parapatric species with hybrid zones. Biometric analyses on experimental F(1) and backcross populations revealed that inheritance of genital morphology is polygenic. Applying Lande's modification of the Castle-Wright estimator to population means and variances to estimate the minimum number of genes involved, we found that a relatively small number of loci is responsible for species differences in genital morphology. In addition, joint-scaling tests indicated that the additive genetic effect accounts for most interspecific differences in genital traits, but dominance and epistatic genetic effects also play roles. Overall, the genetic basis of male and female genitalia is fairly simple, enabling these traits to respond quickly to selection pressures and to diverge rapidly. Our results provide insight into the diversification of genital morphology in carabid beetles, and will hopefully stimulate further studies on the genetic basis of genitalia, such as mapping of quantitative trait loci affecting species-specific genital morphology.

Attenuation of acid induced oesophagitis in VR-1 deficient mice

BACKGROUND AND AIMS

Activation of the vanilloid receptor subtype 1 (VR-1) results in release of proinflammatory peptides which initiate an inflammatory cascade known as neurogenic inflammation. We investigated its role in an acute model of surgically induced oesophagitis.

METHODS

Oesophagitis was induced by pyloric ligation in wild-type and VR-1 deficient mice. A subset of animals were administered the VR-1 antagonist capsazepine, famotidine, or omeprazole one hour before surgery. Five hours after surgery, myeloperoxidase activity (MPO), histological damage scores, intragastric pH, and immunocytochemical analysis of substance P (SP) receptor endocytosis were determined.

RESULTS

Oesophagitis induced knockout mice exhibited significantly lower levels of MPO activity, histological damage scores, and SP receptor endocytosis than wild-type mice. Inflammatory parameters were significantly reduced by acid inhibition and capsazepine in wild-type mice.

CONCLUSIONS

We conclude that acute acid induced oesophagitis is reduced in animals lacking VR-1. This suggests that acid induced oesophagitis may act through VR-1 and that inhibition of the receptor may reduce inflammation.

Species status and phylogeography of two closely related Coptolabrus species (Coleoptera: Carabidae) in South Korea inferred from mitochondrial and nuclear gene sequences

We investigated the species status and intraspecific phylogeography in South Korea of two ground beetle species, Coptolabrus jankowskii and Coptolabrus smaragdinus (Coleoptera: Carabidae), using statistical parsimony networks and nested clade analyses based on sequences from the mitochondrial cytochrome oxidase subunit I (COI) and nuclear phosphoenolpyruvate carboxykinase (PepCK) and wingless (Wg) genes. Although traditional parsimony tree construction generally failed to resolve interspecific relationships and construct biologically meaningful genealogies, analysis using statistical parsimony networks yielded statistically significant inter- and intraspecific genealogical structures. We found that although these two species represent a notable case of trans-species polymorphisms in both mitochondrial and nuclear gene sequences, their status as separate species was evidenced by the nonrandom association between species and nested clades at various nesting levels. The exceptional occurrence of shared identical or very similar COI sequences was considered to be the result of introgressive hybridization. In addition, range expansion and fragmentation events across the Korean Peninsula and adjacent islands were inferred from nested clade phylogeographical analyses. The COI gene revealed the geographical divergence of major eastern and western clades and historical biogeographical events within each major clade, whereas the nuclear PepCK gene, which did not reveal corresponding east-west clades, indicated past fragmentation and range expansion across wide areas that may have been the result of older biogeographical events. Thus, phylogeographical inferences drawn from analyses of mitochondrial and nuclear genes can reveal different and potentially complementary information about phylogeographical processes.

The "mini-elephant trunk" technique of distal anastomosis in total arch replacement through a median sternotomy for a distal aortic arch aneurysm

A median sternotomy is considered to have several advantages over a left thoracotomy as a route for the surgical treatment of a distal aortic arch aneurysm, including less pain and less lung damage. In a median sternotomy, distal anastomosis is such an important problem that we herein present a useful technique to prevent surgical bleeding from it. An invaginated 40-mm-long graft is inserted into the distal aorta, sutured to the aortic wall, unfolded, and anastomosed with a four-limbed tube graft. We applied this "mini-elephant trunk" technique to total arch replacement for both a saccural distal aneurysm, where the distal aorta was transected, and a fusiform aneurysm, where the invaginated graft was sutured by the "inclusion" method. This technique enables a greater surface contact area between the graft and the aortic wall at the distal anastomosis, thus resulting in a reduced risk of bleeding.

Resolution of perivalvular hematoma of the Freestyle stentless aortic root bioprosthesis implanted with a subcoronary technique

The modified subcoronary technique is frequently used to implant the Freestyle aortic root bioprosthesis because of its ease. This technique is primarily associated with hematoma in the potential space between the prosthetic and native aortic walls. We report a case of resolution of perivalvular hematoma around the Freestyle valve 6 months after implantation in a patient with aneurysm of the noncoronary sinus of Valsalva. During follow-up, the patient underwent no significant changes in pressure gradient or degree of regurgitation. Although long-term results are not yet known, the subcoronary technique may be a feasible alternative for patients with aneurysms in the sinus of Valsalva to exclude it, unless the sinotubular junction and aortic annulus are intact.

Relation of intraoperative flow measurement with postoperative quantitative angiographic assessment of coronary artery bypass grafting

BACKGROUND

It is critical to evaluate the anastomotic quality of coronary artery bypass grafting (CABG) in the operating room. The aim of this study is to determine the validity of intraoperative flow measurement for predicting the quality of CABG by comparison with the postoperative quantitative angiographic evaluation of the grafts.

METHODS

Eighty-two grafts, including 37 internal thoracic arteries, were examined intraoperatively with a transit-time flowmeter. Coronary angiograms were performed 14 +/- 5 days after CABG to quantify the diameters at the toe, heel, and anastomosis proper of the grafts.

RESULTS

There were significant differences between patent and nonpatent grafts in all intraoperative flow parameters. However, the only cut-off value to distinguish patent from nonpatent was a fast Fourier transformation (FFT) ratio of 1.0. FFT is the ratio of powers of the fundamental frequency and its first harmonic. Postoperative quantitative angiography indicated that the stenosis was greatest at the heel of the anastomosis. The degree of stenosis at the heel of the anastomosis alone correlated significantly with intraoperative mean flow values.

CONCLUSIONS

Fast Fourier transformation analysis of flow measurement may be useful to differentiate patent grafts intraoperatively. Intraoperative flow measurement may predict the most stenotic part of the anastomosis.

A simple method to determine anastomotic quality of coronary artery bypass grafting in the operating room

Anastomotic quality of coronary artery bypass grafting is directly associated with peri-operative and long-term clinical results. In this study, we investigated a cut-off value for intra-operative flow measurement. This value could be of use to a surgeon in determining the anastomotic quality of grafts. Intra-operative transit-time flow variables (mean flow, pulsatility index, % efficiency, fast Fourier transformation (FFT) of the flow curve) and the 2-week post-operative angiographic findings were examined in 66 coronary artery bypass grafts, including 33 internal thoracic arteries. There were significant differences between patent and non patent grafts in all of the intra-operative flow parameters. Only the FFT ratio, the ratio of powers of the fundamental frequency and its first harmonic, could be utilized as a cut-off value to distinguish patent from non patent grafts. All stenotic or occluded grafts showed an intra-operative FFT ratio of <1.0, while all patent grafts yielded a ratio of >1.0. Based upon these results, we concluded that power spectral analysis of flow measurement might be useful for intra-operative differential diagnosis of the anastomotic quality in coronary artery bypass grafting.

A monoclonal antibody against insect CALNUC recognizes the prooncoprotein EWS specifically in mammalian cells. Immunohistochemical and biochemical studies of the antigen in rat tissues

A monoclonal antibody against insect CALNUC was shown to recognize an 85-kDa nuclear protein specifically in mammalian cells. Amino acid sequencing of the protein purified from rat liver revealed it to be EWS, a prooncoprotein for Ewing sarcomas and related tumors. Using the antibody, distribution of EWS was studied in rat tissues fixed with 4% paraformaldehyde by immunohistochemical methods. On thaw-fixed cryosections or those of perfusion-fixed tissues, almost all cell nuclei showed the specific staining. In immersion-fixed tissues, the staining unexpectedly disappeared in particular tissues (kidney cortex, liver, etc.), although it was recovered by autoclaving the cryosections. Western blotting also demonstrated the ubiquitous expression of EWS in the tissues. In extracts from the liver, the 85-kDa band rapidly disappeared in a Ca(2+)-dependent manner, but never in the testis. The antigen was very labile in kidney homogenates even without Ca2+. Biochemical studies with digoxigenin-labeled EWS showed that the Ca(2+)-dependent disappearance was associated with upward mobility shifts of EWS. These suggested that EWS was ubiquitously expressed in rat tissues, and that the antigen was masked in particular tissues during the immersion fixation.

Participation of histones and histone-modifying enzymes in cell functions through alterations in chromatin structure

Alterations in the chromatin structure are preferentially involved in the regulation of cell functions, including gene expression, in eukaryotes. Three types of mechanisms, by which the alterations are caused have been reported: (i) variants of histone subtypes, (ii) chromatin remodeling, and (iii) post-translational modification. This review focuses mainly on the first and third mechanisms, especially on the acetylation of core histones, one of the third mechanisms. Using the gene targeting technique for the DT40 chicken B cell line, we systematically generated a number of mutants, respectively, devoid of particular genes encoding histones and histone deacetylase(s) (HDACs). Most of the H1 and core histone variants should be involved positively or negatively in the transcription regulation of particular genes. Of the chicken HDACs (chHDACs), chHDAC-2 controls the amount of the IgM H-chain at the steps of both transcription and alternative pre-mRNA processing, and chHDAC-3 is essential for cell viability, whereas chHDAC-1 merely affects gene expression in DT40 cells. These results indicate that HDAC family members should participate, in combination with one another, and/or histone acetyltransferase(s) (HATs), in the acetylation of core histones that regulates gene expression through alterations in the chromatin structure.

Leucine zipper motif of chicken histone acetyltransferase-1 is essential for in vivo and in vitro interactions with the p48 subunit of chicken chromatin assembly factor-1

We cloned cDNA encoding chicken cytoplasmic histone acetyltransferase-1, chHAT-1, comprising 408 amino acids including a putative initiation Met. It exhibits 80.4% identity to the human homolog and possesses a typical leucine zipper motif. The glutathione S:-transferase (GST) pull-down assay, involving truncated and missense mutants of the chicken chromatin assembly factor-1 (chCAF-1)p48, revealed not only that a region (comprising amino acids 376-405 of chCAF-1p48 and containing the seventh WD dipeptide motif) binds to chHAT-1 in vitro, but also that mutation of the motif has no influence on the in vitro interaction. The GST pull-down assay, involving truncated and missense chHAT-1 mutants, established that a region, comprising amino acids 380-408 of chHAT-1 and containing the leucine zipper motif, is required for its in vitro interaction with chCAF-1p48. In addition, mutation of each of four Leu residues in the leucine zipper motif prevents the in vitro interaction. The yeast two-hybrid assay revealed that all four Leu residues within the leucine zipper motif of chHAT-1 are necessary for its in vivo interaction with chCAF-1p48. These results indicate not only that the proper leucine zipper motif of chHAT-1 is essential for its interaction with chCAF-1p48, but also that the propeller structure of chCAF-1p48 expected to act as a platform for protein-protein interactions may not be necessary for this interaction of chHAT-1.

Distinct regions of the chicken p46 polypeptide are required for its in vitro interaction with histones H2B and H4 and histone acetyltransferase-1

We cloned cDNA encoding the chicken p46 polypeptide, chp46, homologous to the p48 subunit of chicken chromatin assembly factor-1, chCAF-1p48. It comprises 424 amino acids including a putative initiation Met, is a member of the WD protein family, with seven WD repeat motifs, and exhibits 90.3% identity to chCAF-1p48 and 94.3% identity to the human and mouse p46 polypeptides (hup46 and mop46). The in vitro immunoprecipitation experiment established that chp46 interacts with histones H2B and H4 and chicken histone acetyltransferase-1, chHAT-1, whereas hup46 interacts with histones H2A and H4 and chHAT-1 and chCAF-1p48 with histone H4 and chHAT-1. The in vitro immunoprecipitation experiment, involving truncated mutants of chp46, revealed not only that two regions comprising amino acids 33-179 and 375-404 are necessary for its binding to H2B, but also that two regions comprising amino acids 1-32 and 405-424 are necessary for its binding to H4. Furthermore, the GST pulldown affinity assay, involving truncated mutants of chp46, revealed that a region comprising amino acids 359-404 (in fact, 375-404) binds to chHAT-1 in vitro. Taken together, these results indicate not only that chp46 should participate differentially in a number of DNA-utilizing processes through interactions of its distinct regions with chHAT-1 and histones H2B and H4, but also that the proper propeller structure of chp46 is not necessary for its interaction with chHAT-1.

Magnesium and fluoride distribution in human cementum with age

Sixty-two human teeth, obtained from subjects aged 11 to 80 years, were used to determine the magnesium and fluoride concentration and distribution with age in human cementum. Transverse sections were prepared from the root region of teeth. Samples, each 30 microm thick, were abraded in sequence from the cementum surface and the cemento-dentine junction by an abrasive micro-sampling technique. Magnesium concentrations were lower in the cementum surface, and increased towards the cemento-dentine junction (CDJ), while fluoride concentrations were higher in cementum surfaces and tended to decrease towards CDJ. Fluoride distribution patterns were similar to that reported earlier while average fluoride concentration increased with age, however, either no change or decreasing tendencies were observed with magnesium.

Oral glucose retention, saliva viscosity and flow rate in 5-year-old children

There are significant differences of glucose retention in site-specificity and individuals. Sixty-two 5-year-old nursery schoolchildren participated in this study on the relation between the viscosity of saliva and flow rate and glucose retention. Each child was instructed to rinse his/her mouth with a glucose solution (0.5 M, 5 ml) and then to spit out. Three minutes after rinsing, glucose retention was determined. Resting saliva was collected by a natural outflow method, then the flow rate was determined. A rotational viscometer was used to determine the viscosity. Glucose retention and flow rate were correlated at the left maxillary primary molars, and glucose retention and viscosity were correlated at the maxillary central primary incisors. It was concluded that glucose retention after glucose mouth rinsing was site-specific, and that glucose retention and the index of decayed, missing and filled primary teeth (dmft) were slightly correlated with the salivary viscosity and flow rate.

Successful preservation of human skin by vitrification

The vitrification technique was applied to the preservation of human skin. This technique was simple, and no expensive equipment was needed. Split-thickness human skins from 8 patients were immersed in vitrification solution for 10 minutes at room temperature, immediately plunged into a liquid nitrogen tank, and cryopreserved for 3 weeks. The vitrification solution consisted of 40% ethylene glycol (vol/vol) and phosphate buffered saline solution that contained 30% Ficoll 70 (vol/vol; Wako Junyaku, Co, Tokyo, Japan) and 0.5 mol/L sucrose. The viability of vitrified and cryopreserved skin was evaluated with the trypan blue dye exclusion test, the methyl-thiazoldiphenyl-tetrazolium (MTT) colorimetric assay, and a culture test of the keratinocytes obtained from vitrified skin. The results of the trypan blue dye exclusion test showed 87.4% of viable cells, and MTT developed an average 0.817 absorbance. When vitrified skin was compared with 4 degrees C refrigerated skins after 3 weeks of storage, the difference of viability was significant both on the trypan blue dye exclusion test (P < .05) and on the MTT assay (P < .01). However, there was no significant difference in the viability of vitrified skins compared with fresh skin. Furthermore, keratinocytes from vitrified skin grew uneventfully in culture test. We used these vitrified skin allografts for patients with flame burns and electric burns. These allografts took well in both cases and promoted wound healing. We concluded that the vitrification method for skin preservation is simple and reliable, and this method could contribute to skin banking.

N-terminal region, C-terminal region, nuclear export signal, and deacetylation activity of histone deacetylase-3 are essential for the viability of the DT40 chicken B cell line

Histone deacetylases (HDACs) are involved in the deacetylation of core histones, which is related to transcription regulation in eukaryotes through alterations in the chromatin structure. We cloned cDNA and genomic DNA encoding a chicken HDAC, chHDAC-3, which was localized in both the nuclei and cytoplasm in DT40 cells. Although one of the two chHDAC-3 alleles could be disrupted with high efficiency, no homozygous mutants were obtained after a second round of the gene-targeting technique due to its necessity for DT40 cells. We introduced a chHDAC-3 transgene under the control of a tetracycline-responsive promoter into the heterozygous mutant and subsequently disrupted the remaining endogenous chHDAC-3 allele to generate the homozygous chHDAC-3-deficient mutant, DeltachHDAC-3/FHDAC3. Inhibition of the expression of the regulatable chHDAC-3 transgene caused apoptotic cell death of the mutant. Complementation experiments involving truncated and missense chHDAC-3 mutant proteins revealed that the 1-23 N-terminal sequence, the 389-417 C-terminal sequence, the nuclear export signal, and the deacetylation activity of chHDAC-3 were essential for the cell viability. Taken together, these results indicate that chHDAC-3 plays an essential role, probably as a scavenger in the cytoplasm, in the proliferation of DT40 cells.

Theoretical analysis of right gastroepiploic artery grafting to right coronary artery

BACKGROUND

The right gastroepiploic artery (GEA) has been used as the second reliable arterial graft for coronary artery bypass grafting (CABG). However, concern regarding the flow competition with the recipient coronary artery has remained.

METHODS

An application of in situ GEA grafting to the right coronary artery (RCA) was studied by using a theoretical model. The theoretical model of CABG was given variables; ie, the diameters and the lengths of both in situ GEA and proximal segment of the RCA, and the degree of proximal stenosis in the RCA. According to the range of these variables obtained from clinical data, the ratio of the GEA flow to the flow of the RCA distal to the anastomosis was calculated.

RESULTS

Main factors to determine the flows in the two parallel paths were the inner diameters of both vessels, and the degree of the proximal stenosis. When the inner diameters of the GEA were 0.5 mm larger than that of the RCA, the GEA carried more than 50% of the total flow of the RCA distal to the anastomosis despite a moderate stenosis in the RCA. When the inner diameter of the GEA was equal to, or 0.5 mm smaller than, that of the RCA, the GEA flow was dominated by the native RCA flow unless the proximal stenosis was critical.

CONCLUSIONS

If the inner diameter of the GEA is 0.5 mm larger than that of the RCA, CABG with the GEA can be applied more widely. If not, the application would basically be limited.

Small-cell carcinoma of the gallbladder: report of a case

We report herein the case of an 81-year-old woman in whom a mass in the gallbladder was revealed by an ultrasound examination conducted as part of a follow-up study for a silent gallstone. The mass showed evidence of invasion into the adjacent liver parenchyma. Under the tentative diagnosis of malignant neoplastic disease originating in the gallbladder, a cholecystectomy with partial hepatectomy was performed. Histological examination of the tumor confirmed a diagnosis of small-cell carcinoma of the gallbladder, which is considered to be a rare type of neoplasm.

Histone H1 variants play individual roles in transcription regulation in the DT40 chicken B cell line

Thirty-nine of the 44 chicken histone genes are located in a major gene cluster of 110 kb, the others being distributed in four separate regions. All 6 H1 genes, which are present in the cluster and encode different variants, are expressed in the DT40 chicken B cell line, at levels ranging from about 5 to 40%. To clarify differences in the natures of these H1 variants, using gene-targeting techniques, we generated a series of DT40 mutants, which are devoid of each of the 5 H1 genes, respectively. Analyses of six H1-deficient mutants, comprising the latter five and a previously generated H1-deficient mutant, revealed that the protein patterns on 2D-PAGE were definitely different from each other, indicating that each H1 variant plays an individual role in the transcription regulation of specific genes in DT40 cells.

Protein kinase C and the opposite regulation of sodium channel alpha- and beta1-subunit mRNA levels in adrenal chromaffin cells

Our previous [3H]saxitoxin binding and 22Na influx assays showed that treatment of cultured bovine adrenal chromaffin cells with 12-O-tetradecanoylphorbol 13-acetate (TPA) or phorbol 12,13-dibutyrate (PDBu), an activator of protein kinase C (PKC), decreased the number of cell surface Na channels (IC50 = 19 nM) but did not alter their pharmacological properties; Na channel down-regulation developed within 3 h, reached the peak decrease of 53% at 15 h, and was mediated by transcriptional/translational events. In the present study, treatment with 100 nM TPA lowered the Na channel alpha-subunit mRNA level by 34 and 52% at 3 and 6 h, followed by restoration to the pretreatment level at 24 h, whereas 100 nM TPA elevated the Na channel beta1-subunit mRNA level by 13-61% between 12 and 48 h. Reduction of alpha-subunit mRNA level by TPA was concentration-dependent (IC50 = 18 nM) and was mimicked by PDBu but not by the biologically inactive 4alpha-TPA; it was prevented by H-7, an inhibitor of PKC, but not by HA-1004, a less active analogue of H7, or by H-89, an inhibitor of cyclic AMP-dependent protein kinase. Treatment with cycloheximide, an inhibitor of protein synthesis, per se sustainingly increased the alpha-subunit mRNA level and decreased the beta1-subunit mRNA level for 24 h; also, the TPA-induced decrease of alpha-subunit mRNA and increase of beta1-subunit mRNA were both totally prevented for 24 h by concurrent treatment with cycloheximide. Nuclear run-on assay showed that TPA treatment did not alter the transcriptional rate of the alpha-subunit gene. A stability study using actinomycin D, an inhibitor of RNA synthesis, revealed that TPA treatment shortened the t(1/2) of alpha-subunit mRNA from 18.8 to 3.7 h. These results suggest that Na channel alpha- and beta-subunit mRNA levels are differentially down- and up-regulated via PKC; the process may be mediated via an induction of as yet unidentified short-lived protein(s), which may culminate in the destabilization of alpha-subunit mRNA without altering alpha-subunit gene transcription.