The disturbances of object vision and spatial vision in Alzheimer's disease

Thirty-one patients with mild-to-moderate Alzheimer's disease (AD) underwent a test battery of complex visual tasks. We assessed the scores using a principal-factor analysis to elucidate the underlying deficits. There were three independent factors: The first factor included the tasks of identifying and comparing forms of visual stimuli. The second factor consisted of digit span and digit symbol tasks, and the third factor consisted of a specified visual counting task. We considered these three factors as representing the dysfunctions of object recognition, general attention and spatial recognition, respectively. These results underline the disturbances of the two visual systems, object vision and spatial vision, in early-AD patients.

[A case of conjunctival mucosal neuroma without multiple endocrine neoplasia]

Non-traumatic conjunctival mucosal neuroma (CMN) is usually complicated by multiple endocrine neoplasia (MEN). We report the first case of CMN without MEN type IIb (III). A 14-year-old Japanese girl had CMN in the conjunctival fornix of right eye. CMN was diagnosed from histopathology and immunohistochemistry. T1-weighted magnetic resonance imaging (MRI) showed a circular scribed iso-intensity signal, and the T2-weighted image showed iso-or high-intensity signal. There were no abnormal findings in the tongue, the neck or the abdomen.

Expression and localization of bone morphogenetic proteins (BMPs) and BMP receptors in ossification of the ligamentum flavum

To clarify the pathogenesis of ossification of the ligamentum flavum (OLF), we examined the expression and localization of bone morphogenetic proteins (BMPs) and their receptors (BMPRs) in the ligamentum flavum of the patients with OLF by immunohistochemical staining and compared them with staining patterns in control patients. The BMPRs appeared extensively in mature and immature chondrocytes around the calcified zone and in spindle-shaped cells and round cells in the remote part from ossified foci in examined tissue of OLF. The ligands for BMPRs, BMP-2/-4 and osteogenic protein-1 (OP-1)/BMP-7, colocalized in OLF patients. In the control cases, expression of BMPs and BMPRs was observed around the calcified zone at the insertion of the ligamentum flavum to the bone, and limited expression was found in the smaller range. Thus, the expression profile of BMPs and BMPRs in OLF patients was entirely different from the control patients, suggesting that BMPs may be involved in promoting endochondral ossification at ectopic ossification sites in OLF, and that ossification activity is continuous in these patients.

Overexpression of resistance-related proteins (metallothioneins, glutathione-S-transferase pi, heat shock protein 27, and lung resistance-related protein) in osteosarcoma. Relationship with poor prognosis

BACKGROUND

The prognosis for patients with osteosarcoma has improved over the past 20 years, mainly due to developments in chemotherapy. Some proteins have been reported to show drug resistance. Theoretically, overexpression of some of these proteins makes treatment difficult, leading to poorer outcome.

METHODS

Specimens taken from conventional osteosarcomas of the extremity bones from 60 patients younger than 30 years were used. In all cases, preoperative oncostatic chemotherapy was undertaken after biopsy. If available, biopsy specimens were also used for sequential comparison. Among resistance-related proteins, expression of metallothioneins (MTs), glutathione-S-transferase pi (GST pi), heat shock protein 27 (Hsp27), and lung resistance-related protein (LRP) was evaluated immunohistochemically in paraffin sections. The log rank test was used for univariate analysis and the Cox regression model for multivariate analysis.

RESULTS

At biopsy, only overexpression of Hsp27 was associated with poor prognosis. At surgery, a relationship was observed between poor prognosis and overexpression of GST pi, Hsp27, and LRP. Groups overexpressing one protein tended to overexpress another. Overexpression of these proteins in surgical specimens also correlated with histologic response to preoperative chemotherapy and clinical stage. In multivariate analysis, Hsp27 overexpression at biopsy was an independent prognostic factor.

CONCLUSIONS

Inherent overexpression of Hsp27 is independently related to poor outcome in osteosarcoma patients. Overexpression of GST pi, Hsp27, and LRP at surgery might be associated with failure of preoperative chemotherapy. Control of the expression of these proteins may improve the outcome for patients with osteosarcoma.

Activation of blood coagulation factor X by arginine-specific cysteine proteinases (gingipain-Rs) from Porphyromonas gingivalis

The effect of two arginine-specific cysteine proteinases (gingipain Rs) from Porphyromonas gingivalis, a causative bacterium of adult periodontitis, on human blood coagulation was investigated. Activated partial thromboplastin time and prothrombin time were shortened by these proteinases, with a 95-kDa gingipain R containing adhesin domains being 5-fold more efficient in comparison to a 50-kDa gingipain R containing the catalytic domain alone. The 50-kDa enzyme reduced each coagulation time in several plasmas deficient in various coagulation factors, while it was ineffective in factor X-deficient plasma unless reconstituted with this protein. Each proteinase activated factor X in a dose- and time-dependent manner, with Michaelis constants (Km) being found to be lower than the normal plasma factor X concentration, strongly suggesting that factor X activation by gingipain Rs, especially the 95-kDa form which is strongly activated by phospholipids, could occur in plasma. This is the first report of factor X activation by bacterial proteinases and indicates that the gingipain Rs could be responsible for the production of thrombin and, indirectly, with the generation of prostaglandins, interleukin-1, etc., which have been found to be associated with the development of periodontitis induced by P. gingivalis infections. Furthermore, the data support the hypothesis that induction of blood coagulation by bacterial proteinases may be a causative agent in the pathogenesis of disseminated intravascular coagulation in sepsis.

Overexpression of resistance-related proteins (metallothioneins, glutathione-S-transferase pi, heat shock protein 27, and lung resistance-related protein) in osteosarcoma. Relationship with poor prognosis

BACKGROUND

The prognosis for patients with osteosarcoma has improved over the past 20 years, mainly due to developments in chemotherapy. Some proteins have been reported to show drug resistance. Theoretically, overexpression of some of these proteins makes treatment difficult, leading to poorer outcome.

METHODS

Specimens taken from conventional osteosarcomas of the extremity bones from 60 patients younger than 30 years were used. In all cases, preoperative oncostatic chemotherapy was undertaken after biopsy. If available, biopsy specimens were also used for sequential comparison. Among resistance-related proteins, expression of metallothioneins (MTs), glutathione-S-transferase pi (GST pi), heat shock protein 27 (Hsp27), and lung resistance-related protein (LRP) was evaluated immunohistochemically in paraffin sections. The log rank test was used for univariate analysis and the Cox regression model for multivariate analysis.

RESULTS

At biopsy, only overexpression of Hsp27 was associated with poor prognosis. At surgery, a relationship was observed between poor prognosis and overexpression of GST pi, Hsp27, and LRP. Groups overexpressing one protein tended to overexpress another. Overexpression of these proteins in surgical specimens also correlated with histologic response to preoperative chemotherapy and clinical stage. In multivariate analysis, Hsp27 overexpression at biopsy was an independent prognostic factor.

CONCLUSIONS

Inherent overexpression of Hsp27 is independently related to poor outcome in osteosarcoma patients. Overexpression of GST pi, Hsp27, and LRP at surgery might be associated with failure of preoperative chemotherapy. Control of the expression of these proteins may improve the outcome for patients with osteosarcoma.

Gastrointestinal stromal tumor of the stomach

We report a case of gastrointestinal stromal tumor (GIST) of the stomach. The patient was a 79-year-old woman with two gastric submucosal tumors detected by ultrasonography. Proximal gastrectomy was carried out and the tumors were diagnosed as GIST by histological and immunohistochemical investigations. Mesenchymal tumors of the gastrointestinal tract have been traditionally regarded as largely leiomyomatous lesions. However, GIST and other tumors have been distinguished recently on the basis of tumor cell differentiation shown by immunohistochemical studies. We discuss the concept and the immunohistochemical characteristics of GIST.

Cytokeratin 19 fragment in serum and tissues of patients with pancreatic diseases

CONCLUSION

The present study has shown that increased serum levels of cytokeratin 19 fragment reflect increases in the size of the pancreatic carcinomas, although the sensitivity for detecting small pancreatic carcinomas was low.

BACKGROUND

Cytokeratin is a member of the intermediate family of filaments in epithelial cells. The cytokeratin 19 fragment is an acidic cytokeratin, which is found in various epithelial tissues. Recently, the serum fragment of cytokeratin 19 has been measured and found to be a good marker for squamous cell carcinoma. Cytokeratin 19 is known to be expressed in normal pancreatic tissues and pancreatic carcinomas. However, serum cytokeratin 19 levels in pancreatic diseases have not been precisely detailed.

METHODS

In this study, we evaluated serum cytokeratin 19 levels and the immunohistochemical expression of cytokeratin 19 in various pancreatic diseases.

RESULTS

Serum cytokeratin 19 levels were high (> 2 ng/mL) in 51 of 99 (52%) cases of pancreatic duct cell carcinoma, but were low in all 24 cases of chronic pancreatitis and in 7 cases of islet cell tumors. The sensitivity of the cytokeratin 19 assay increased with increased size of the pancreatic carcinomas, but was not influenced by the presence of obstructive jaundice. Immunohistochemical studies using a monoclonal anticytokeratin 19 antibody showed that staining for cytokeratin was positive in all 38 of the pancreatic carcinomas examined and in 2 of 6 islet tumors.

Clinical significance of serum p53 antigen in patients with pancreatic carcinomas

BACKGROUND

Alterations in the p53 gene are often found in pancreatic cancer, and accumulation of the p53 protein has been noted in tumour cells.

AIMS

To investigate whether serum p53 protein concentrations could be used as markers for p53 gene mutations in neoplasms of the pancreas.

METHODS

Serum p53 protein concentrations were determined by an enzyme linked immunosorbent assay (ELISA) in 104 cases of pancreatic adenocarcinoma, and 61 matched formalin fixed tissue sections were also stained by an anti-p53 DO-7 monoclonal antibody.

RESULTS

The mean serum concentration of p53 protein in the adenocarcinoma patients was 0.27 (SEM 0.02) ng/ml, and was significantly higher than in 35 healthy blood donors (0.15 (0.02) ng/ml, SD = 0.11) or in 15 cases of chronic pancreatitis (0.15 (0.02) ng/ml). Adopting an arbitrary cut off value for the serum p53 protein concentration of 0.37 ng/ml, which corresponded to a value 2 SD above the mean value from the healthy blood donors, positive serum p53 protein concentrations were found in 23 out of 104 (22.1%) patients with adenocarcinomas examined, 16 out of 47 (34.0%) patients with carcinomas with distant metastases, but only seven of 57 patients (12.3%) with carcinomas without metastases (p < 0.05). In 11 patients with pancreatic adenocarcinomas, the mean serum p53 protein concentration after tumour resection was 0.21 (0.05) ng/ml, and had decreased compared with the preoperative concentrations (0.25 (0.05) ng/ml) (P < 0.05). There were no significant associations between the serum concentrations of p53 protein and serum concentrations of markers such as CA19-9 or CEA; however, serum concentrations of p53 protein demonstrated a potential role as an additional tumour marker. Immunohistochemical studies disclosed that the p53 protein was expressed in 28 out of 61 pancreatic adenocarcinomas (45.9%). Serum p53 protein concentrations in the positively immunostained cases were significantly higher than in the negatively immunostained cases (0.35 (0.05) ng/ml v 0.15 (0.01) ng/ml; p < 0.005). Furthermore, positive immunostaining for p53 protein was found in eight out of 10 (80%) serum positive p53 protein cases with adenocarcinomas.

CONCLUSION

An increase in serum p53 protein concentrations appears during the progression of pancreatic adenocarcinoma and correlates with the accumulation of p53 protein as a result of a mutation of the p53 gene. An analysis of p53 antigen concentrations can detect p53 gene alterations, which could be useful for the selection of treatment regimens.

Selective determination of amitriptyline and nortriptyline in human plasma by HPLC with ultraviolet and particle beam mass spectrometry

A selective, sensitive, and reliable method was devised to determine concentrations of amitriptyline and its major metabolite, nortriptyline, in human plasma using high-performance liquid chromatography (HPLC) combined with UV and particle beam mass spectrometry (PBMS). Amitriptyline and nortriptyline were effectively extracted in a three-step solvent extraction procedure. Imipramine was used as the internal standard (IS). Amitriptyline, nortriptyline, and the IS were clearly separated by HPLC on a silica column with the mobile phase of acetonitrile-0.1 M ammonium acetate (94:6, v/v). The calibration curves were linear in the concentration range of 10-1000 ng/g for both compounds with UV and PBMS detections. The lower limits of detection were 5 ng/g for amitriptyline and 10 ng/g for nortriptyline with UV detection and 2 ng/g for amitriptyline and 5 ng/g for nortriptyline with PBMS detection. The absolute recoveries were 58% for amitriptyline and 47% for nortriptyline at a concentration of 50 ng/g. This method proved most useful in accurately identifying amitriptyline and nortriptyline in tissues from an autopsied individual.

Death attributed to the toxic interaction of triazolam, amitriptyline and other psychotropic drugs

A 71-year-old man was found dead in a car into which exhaust fumes had been introduced. His wife who was in the same car recovered consciousness following hospitalization. She claimed that they had both attempted suicide by taking a large number of sleeping pills. Autopsy revealed no significant external injuries or medical disorders that would have led to the husband's death. The concentrations of alcohol and carbon-monoxide hemoglobin in his whole blood were 0.26 mg/ml and < 10%, respectively. Therefore, poisoning by carbon monoxide from the exhaust fumes was ruled out, and further toxicological examinations were undertaken. Triazolam, pentobarbital, amitriptyline and bromazepam were all detected in the tissues of the victim; whole blood concentrations were 45.60, 386.4, 521.2 and 166.7 ng/g, respectively. Triazolam (7.350 ng/g) and pentobarbital (288.2 ng/g) were also detected in the whole blood of the wife, collected 17 h after admission to hospital. When evaluating these results in the light of existing literature, we concluded that the victim and his wife had indeed attempted suicide by taking triazolam and pentobarbital. However, only the man had died of triazolam poisoning due to its apparently lethal combination with amitriptyline and other psychotropic drugs which had been prescribed to treat his depression.

Rat liver 4S-benzo[a]pyrene-binding protein is distinct from glycine N-methyltransferase

Rat liver 4S-benzo[a]pyrene-binding protein (BAP) was reported to be identical to the subunit (Mr 32,500) of the tetrameric glycine N-methyltransferase (GNMT). We have reevaluated this study. When a liver cytosol was subjected to Sephacryl S-200 gel permeation chromatography, enzyme activity as well as cross-reactivity with anti-GNMT antibody were found only at the elution position of the purified GNMT. Chromatograph of the cytosol pretreated with [3H]benzo[a]pyrene showed two peaks in the void volume and at the position of an approximate Mr of 40,000. The latter, corresponding to the 4 S BAP, did not cross-react with the anti-GNMT antibody. An extract of nuclei in which GNMT was proposed to act as a mediator of cytochrome P4501A1 gene expression contained the tetrameric GNMT but no binding activity. The lung, in which no GNMT mRNA occurred, had the 4 S BAP. Extracts of Escherichia coli and COS-7 cells expressing large amounts of GNMT showed no 4 S BAP. These findings suggest that the 4 S BAP is distinct from the subunit of GNMT.

Functional importance of Shc tyrosine 317 on insulin signaling in Rat1 fibroblasts expressing insulin receptors

Shc is phosphorylated on Tyr-317, which serves as a docking site for Grb2. To investigate the specific role of Shc phosphorylation and Shc.Grb2 coupling on insulin signaling, we generated expression vectors for wild-type (WT-Shc) and a mutant Shc with a Tyr-317 --> Phe substitution (317Y/F-Shc) and stably transfected them into Rat1 fibroblasts expressing insulin receptors (HIRc). From different clonal cell lines, cells expressing 10 times greater amounts of WT-Shc or 317Y/F-Shc compared with endogenous Shc were chosen for analysis of insulin signaling. Insulin-induced Shc phosphorylation and subsequent association with Grb2 was enhanced in WT-Shc cells. Because of competition between Shc and IRS-1 for interaction with the insulin receptor, insulin-stimulated tyrosine phosphorylation of IRS-1 was decreased in WT-Shc cells compared with that in HIRc cells. Likewise, reduction of endogenous Shc expression by antisense Shc mRNA resulted in increased insulin stimulation of IRS-1 phosphorylation. Although 317Y/F-Shc was also able to interact with insulin receptor, decreased amounts of Shc phosphorylation and Shc association with Grb2 were observed in 317Y/F-Shc cells, indicating that 317Y/F-Shc functions as a dominant-negative mutant. The kinetics of mitogen-activated protein (MAP) kinase activation closely paralleled the kinetics of Shc phosphorylation. Thus, insulin stimulation of MAP kinase activation occurred more rapidly and was prolonged in WT-Shc cells, while the activation was delayed and transient in 317Y/F-Shc cells compared with that in HIRc cells. Importantly, WT-Shc cells displayed enhanced sensitivity to insulin stimulation of thymidine and bromodeoxyuridine incorporation, whereas the sensitivity was decreased in 317Y/F-Shc cells. These results indicate that Shc Tyr-317 phosphorylation plays an important role, via coupling with Grb2 and competition with IRS-1, in signal transduction to MAP kinase by insulin, ultimately leading to mitogenesis in Rat1 fibroblasts.

Examining the diagnostic utility of the Fuld cholinergic deficit profile on the Japanese WAIS-R

The diagnostic utility of the Fuld cholinergic deficit profile (Fuld, 1984) to dementia of the Alzheimer type (DAT) was evaluated on the Japanese version of the WAIS-R. Profiles were calculated for groups of subjects with DAT(n = 236), vascular dementia (n = 29), frontotemporal dementia (n = 22), and hydrocephalic dementia (n = 10). The frequency of positive profile occurrence for the subject groups was as follows: 23/236 for DAT (9.7%), 2/29 (6.9%) for vascular dementia, 2/22 (9.1%) for frontotemporal dementia, and 2/10 (20%) for hydrocephalic dementia. No significant difference in the frequency of positive profile occurrence was revealed across four types of dementia. We conclude from these findings that the Fuld profile lacks the diagnostic utility on the Japanese WAIS-R.

Bone morphogenetic protein receptors and activin receptors are highly expressed in ossified ligament tissues of patients with ossification of the posterior longitudinal ligament

Ossification of the posterior longitudinal ligament (OPLL) is a pathological ossification in the spinal ligament, with formation of ectopic bone mainly through endochondral ossification. Bone morphogenetic proteins (BMPs) and activins are multifunctional proteins that belong to the transforming growth factor-beta superfamily and that have been implicated in the formation of new bone and cartilage. BMPs and activins signal via type I and type II receptors for BMPs (BMPRs) and activins (ActRs), respectively. OP-1/BMP-7 binds to BMPR-II and ActR-II and forms complexes with BMPR-IA and -IB and ActR-I. We studied the expression of BMPR-IA, -IB, and -II, ActR-I, ActR-II, and OP-1/BMP-7 by immunohistochemistry in ossified ligament tissues of patients with OPLL and control ligament tissues from patients with cervical disc herniation. The expression of BMPRs and ActRs was elevated in OPLL compared with controls. Expressions of BMPR-IA, -IB, and -II were observed not only in chondrocytes at the fibrocartilage tissue around the calcified zone but also in fibroblast-like spindle cells at the nonossified ligament. ActR-I and -II were found co-localized in the hypertrophic chondrocytes near the calcified zone and in the ossified tissue. OP-1/BMP-7 was expressed in chondrocytes near the calcified zone. In the control cases, the BMPRs and ActRs were only weakly expressed in the fibrocartilage tissue at the site of ligament attachments to bone and OP-1/BMP-7 was not detected. Enhanced expression of BMPRs at the nonossified ligament in OPLL patients suggests that these cells have a greater potential to differentiate into osteogenic cells than ligament cells from non-OPLL patients. The high expression of BMPRs and ActRs in the ectopic ossified ligament suggests that BMPs and activin may be tightly involved in the pathological ossification process of OPLL.

Detection of drugs and poisons in postmortem tissues--determination of paraquat in tissues of rabbits buried underground

The possibility of detecting paraquat in tissues of rabbits buried underground over a 2-year period was examined. Paraquat (1.2 g) was given orally to rabbits, which were sacrificed 1 h after administration. The animals were buried underground, and the skeletal muscles and the bones were collected 3 and 6 months after death, and 3, 6, 12, and 24 months after death, respectively. Paraquat was present in all bone marrow samples, showing a slight decrease in concentration until 12 months. Paraquat was also detected in all skeletal muscle samples, showing almost no change in concentration until 6 months. These results indicate that intoxication with paraquat as well as the degree of poisoning can both be determined from the skeletal muscles and bone marrow of cadavers which have been buried underground for a long period of time even in human cases.

Sensitive determination of sulpiride in human plasma by high-performance liquid chromatography

We developed a simple, sensitive and reliable method for the determination of sulpiride, a specific antipsychotic drug, in human plasma using high-performance liquid chromatography. A structurally related benzamide, tiapride, was used as the internal standard. A Sep-Pak C18 cartridge was used to extract a sample from 1 ml of plasma. The extract was dissolved in methylene chloride, and then back-extracted with 0.01 M hydrochloric acid. The aqueous layer was put on a octadecylsilica column with a mobile phase of 50% acetonitrile in 0.01 M phosphate buffer (pH 3.0). A fluorescence detector with excitation at 300 nm and emission at 365 nm was used for detection. The calibration curve was linear in the concentration range of 10-1500 ng/ml, and the lower limit of detection was 1 ng/ml. We used this method to examine plasma levels of sulpiride in 14 inpatients being treated with sulpiride for 6 months. The determined plasma levels were 70.1-1121.2 ng/ml, and the correlation between daily dose and plasma concentration was positive. This simple, reliable method is expected to be put to good use in forensic and hospital laboratories.

Selective determination of sultopride in human plasma using high-performance liquid chromatography with ultraviolet detection and particle beam mass spectrometry

We developed a sensitive and selective method for determining levels of sultopride, a neuroleptic drug of the substituted benzamide, in human plasma using high-performance liquid chromatography (HPLC) combined with UV detection and particle beam mass spectrometry (PBMS). Sultopride was extracted with tert.-butylmethyl ether using a salting-out technique. Tiapride served as an internal standard (I.S.). Sultopride and I.S. were separated by HPLC on a silica column with a mobile phase of acetonitrile-0.1 M ammonium acetate (94:6, v/v). The calibration curves were linear over the concentration range from 5 to 1000 ng/ml by HPLC with UV detection and from 10 to 1000 ng/ml with PBMS detection. The limit of quantitation was 5 ng/ml with UV detection and 10 ng/ml with PBMS detection. The absolute recovery was 92% and the within-day coefficients of variation were 2.9-7.1% at plasma concentrations from 50 to 500 ng/ml, determined by HPLC with UV detection. Using this method, we measured the plasma concentrations of sultopride with replicate analyses in four hospitalized patients and steady-state plasma levels were determined to be 161.6 +/- 30.8, 321.1 +/- 93.7, 726.5 +/- 143.1 and 1273.6 +/- 211.2 ng/ml, respectively.

[Japanese version of the Neuropsychiatric Inventory--a scoring system for neuropsychiatric disturbance in dementia patients]

BACKGROUND AND PURPOSE

Neuropsychiatric disturbances are common and burdensome symptoms of dementias. Assessment and measurement of neuropsychiatric disturbances are indispensable to the management of patients with dementia and for clinical research. No standardized instruments have been developed for these purposes in Japan. The Neuropsychiatric Inventory (NPI), developed by Cummings et al., is a standardized, validated, and reliable tool to assess a wide range of neuropsychiatric derangements in patients with dementia, and has been used in clinical studies in North America. In this study, we prepared a Japanese version of the NPI and tested its reliability and usefulness in dementia patients.

SUBJECTS AND METHODS

The subjects were 174 patients with dementia, including Alzheimer's disease (140), frontotemporal dementia (12), vascular dementia (19), and normal pressure hydrocephalus (3), whose diagnosis was made on the basis of the results of extensive examinations including MRI and PET/SPECT of the brain and appropriate clinical diagnostic criteria for each disorder. The subjects consisted of 133 women and 41 men; their mean age was 72.6 +/- 7.7 years (S.D.; range: 49 to 88) years. An examiner (neurologist) used the NPI to interview a caregiver familiar with the patient's everyday behavior. In 24 randomly selected patients interview was repeated by another examiner (psychiatrist) one month later, and test-retest reliability was evaluated. The Clinical Dementia Rating (CDR), the Mini-Mental State Examination (MMSE), and the Alzheimer's Disease Assessment Scale (ADAS) were used to assess the severity of the dementia and cognitive impairment.

RESULTS

The MMSE scores ranged from 5 to 29 (mean +/- SD = 19.0 +/- 4.8) and the ADAS scores ranged from 7 to 63 (24.3 +/- 10.9). The CDR score was 0.5 in 17 patients, 1 in 95 patients, 2 in 52 patients, and 3 in 10 patient. Test-retest reliability of each score was acceptably high, and the correlation coefficient for each score obtained by repeated assessments in this study was similar to the coefficient in the original report. Apathy was the most common behavior in the ten abnormal behavioral domains, and euphoria was the least common. The prevalence of abnormal findings was also comparable to the results in the original report. The total NPI scores and many of the NPI subscale scores were significantly correlated with both the severity of dementia and cognitive impairment.

CONCLUSIONS

This Japanese version of NPI, whose reliability and competency are comparable to those of the original version, is a reliable and useful tool for measuring neuropsychiatric disturbances in dementia patients.

Alteration of white matter MR signal intensity in frontotemporal dementia

PURPOSE

To determine the diagnostic potential of MR imaging to show white matter involvement in frontotemporal dementia.

METHODS

We evaluated MR signal intensity in cerebral white matter by visually inspecting and by quantitatively measuring signal intensity on MR images in 22 patients with frontotemporal dementia. The findings were compared with those in 22 age- and sex-matched patients who had had Alzheimer disease for the same length of time and with 16 age- and sex-matched healthy control subjects.

RESULTS

Patients with frontotemporal dementia had a significant increase in white matter signal intensity in the frontal and/or temporal lobes on T2- and proton density-weighted images. Visual inspection of regular proton density-weighted images and measurements made on the T2- and proton density-weighted images were sensitive to changes in white matter signal.

CONCLUSION

Increased MR signal intensity in the frontotemporal white matter on T2- and proton density-weighted MR images is a useful diagnostic sign of frontotemporal dementia and distinguishes this condition from Alzheimer disease.

Usefulness of elastica-van Gieson stain for the pathomorphological diagnosis of a cutaneous electric mark--a fatal electrocution case during arc welding

Identification of an electric mark on a body is required for a precise diagnosis of electrocution at the time of forensic autopsy. We applied Elastica-van Gieson (EVG) stain as a means of obtaining the pathomorphological diagnosis of a cutaneous electric mark in relation to a fatal electrocution case. Using EVG stain, the characteristic findings of electric marks, such as elongation of basal-cell nuclei and vacuolation of cells within the epidermis, were clearly observed, while in addition, disarrangement of elastic fibers in the connective tissues within the dermis was also demonstrated. EVG staining was considered to be useful in enabling pathomorphological observations of a cutaneous electric mark to be made.

Regional cerebral blood flow and oxygen metabolism in a patient with Korsakoff syndrome

We report a functional neuroimaging study of a patient clinically diagnosed with Korsakoff syndrome. Positron emission tomography (PET) with the 15O inhalation method showed decreased regional cerebral blood flow (rCBF) and decreased regional cerebral metabolic ratio for oxygen (rCMRO2) in the bilateral fronto-temporal areas and in the left thalamus. These results suggest that dysfunction of the frontal-thalamic neural network plays a role in the disturbance of Korsakoff syndrome.

Identification of Smad2, a human Mad-related protein in the transforming growth factor beta signaling pathway

Transforming growth factor-beta (TGF-beta) superfamily members are multifunctional cytokines that exert their effects via heteromeric complexes of two distinct serine and threonine kinase receptors. Drosophila mothers against decapentaplegic and related genes in Caenorhabditis elegans, Xenopus, and mammals were shown to function downstream in the intracellular signaling pathways of TGF-beta superfamily members. Here we report the cloning of a Mad-related protein, termed Sma- and Mad-related protein 2 (Smad2). TGF-beta stimulated the phosphorylation and nuclear translocation of Smad2 in nontransfected Mv1Lu cells. In addition, we demonstrated that TGF-beta and activin mediated phosphorylation of Smad2 after its overexpression with appropriate type I and II receptors in COS cells. Smad2 and Smad1 were found to be broadly expressed in human tissues. Smad2 is closely linked to DPC4 on chromosome 18q21.1, a region often deleted in human cancers. Cells that lack Smad2 may escape from TGF-beta-mediated growth inhibition and promote cancer progression.