Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism

OBJECTIVE

We recently demonstrated that mild primary hyperparathyroidism (PHPT) is associated with increased carotid intima-media thickness (IMT) and stiffness, and increased aortic valve calcification. It is unclear whether parathyroidectomy (PTX) improves these abnormalities. The purpose of this study was to determine whether cardiovascular abnormalities in PHPT improve with PTX.

DESIGN

Forty-four patients with PHPT were studied using carotid ultrasound and transthoracic echocardiography before and after PTX. Carotid IMT, carotid plaque and stiffness, left ventricular mass index (LVMI), myocardial and valvular calcification, and diastolic function were measured before, 1- and 2-year post-PTX.

RESULTS

Two years after PTX, increased carotid stiffness tended to decline to the normal range (17%, P=0.056) while elevated carotid IMT did not improve. Carotid plaque number and thickness, LVMI and cardiac calcifications did not change after PTX, while some measures of diastolic function (isovolumic relaxation time (IVRT) and tissue Doppler peak early diastolic velocity) worsened within the normal range. Indices did improve in patients with cardiovascular abnormalities at baseline. Increased carotid stiffness improved by 28% (P=0.004), a decline likely to be of clinical significance. More limited improvements also occurred in elevated IMT (3%, P=0.017) and abnormal IVRT (13%, P<0.05), a measure of diastolic dysfunction.

CONCLUSIONS

In mild PHPT, PTX led to modest changes in some cardiovascular indices. Improvements were mainly evident in those with preexisting cardiovascular abnormalities, particularly elevated carotid stiffness. These findings are reassuring with regard to current international guidelines that do not include cardiovascular disease as a criterion for PTX.

Experimental evidence of reaction-driven miscible viscous fingering

An experimental demonstration of reaction-driven viscous fingering developing when a more viscous solution of a reactant A displaces a less viscous miscible solution of another reactant B is presented. In the absence of reaction, such a displacement of one fluid by another less mobile one is classically stable. However, a simple A+B→C reaction can destabilize this interface if the product C is either more or less viscous than both reactant solutions. Using the pH dependence of the viscosity of some polymer solutions, we provide experimental evidence of both scenarios. We demonstrate quantitatively that reactive viscous fingering results from the buildup in time of nonmonotonic viscosity profiles with patterns behind or ahead of the reaction zone, depending on whether the product is more or less viscous than the reactants. The experimental findings are backed up by numerical simulations.

Determinants of outcomes following acute child encephalopathy and encephalitis: pivotal effect of early and delayed cooling

BACKGROUND

Acute encephalopathy/encephalitis is one of the most important causatives of mortality and neurological deficit during childhood. The aim of this retrospective observational study was to investigate clinical variables and therapeutic options associated with the outcome of children with acute encephalopathy/encephalitis.

METHODS

Relationships between the clinical information at admission and the neurological outcome evaluated using Pediatric Cerebral Performance Category Scale (PCPC) at 12 months after admission were assessed in 43 patients who were treated at 10 Japanese paediatric intensive care units.

RESULTS

Sixteen patients were cared for at normothermia, whereas mild hypothermia was applied to 27 children. In univariate analysis, ages ≤ 18 months, marked elevation in serum lactate dehydrogenase (LD) and aspartate transaminase, diagnosis of either acute necrotising encephalopathy or haemorrhagic shock and encephalopathy syndrome and longer hypothermic periods were associated with increased risks of death or severe neurological deficit, whereas hypothermia showed pivotal effects: the outcome of children cooled after 12 h of diagnosis was statistically invariant with normothermic children, but was significantly worse compared with children cooled ≤ 12 h. In multivariate analysis, younger ages and elevated serum LD were associated with adverse outcomes, whereas early initiation of cooling was related to favourable outcomes. For normothermic children, PCPC scores were dependent on the computed tomographic findings suggestive of cerebral oedema, serum LD levels and Glasgow Coma Scale at admission. For hypothermic children, PCPC scores depended on longer delays in cooling initiation.

CONCLUSION

Without therapeutic hypothermia, the outcome of children was determined by variables suggestive of the severity of encephalopathy/encephalitis at admission. Hypothermia may have pivotal impacts on the outcome of children according to the timing of cooling initiation following acute encephalopathy/encephalitis.

Influence of leukotriene pathway polymorphisms on clinical responses to montelukast in Japanese patients with asthma

WHAT IS KNOWN AND OBJECTIVE

Montelukast, a cysteinyl leukotriene receptor 1 antagonist, is safe and efficacious in patients with asthma. The mechanisms underlying the significant interpatient variability in response to montelukast are not clear but are believed to be, in part, because of genetic variability.

METHODS

To examine the associations between polymorphisms in candidate genes in the leukotriene pathway and outcomes in patients with asthma on montelukast for 4-8 weeks, we evaluated the changes in peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV(1·0) ) and patients' subjective symptom before and after montelukast treatment. DNA was collected from 252 Japanese participants.

RESULTS AND DISCUSSION

Two single-nucleotide polymorphisms (SNPs) in the ALOX5 (rs2115819) and LTA4H (rs2660845) genes were successfully typed. There was no difference between members of the general population (n = 200) and patients (n = 52) in each genotype frequency. Significant associations were found between SNP genotypes in the LTA4H gene and changes in PEF and FEV(1·0) . The PEF and FEV(1·0) responses to montelukast in the A/A genotypes (n = 4) for the LTA4H SNP were significantly higher than those in the G allele carriers (A/G+G/G) (n = 17).

WHAT IS NEW AND CONCLUSION

Despite the small sample size, our results suggest that genetic variation in leukotriene pathway candidate genes contributes to variability in clinical responses to montelukast in Japanese patients with asthma.

Electronic Properties of Silicon - M Binary Clusters (M = C & Na)

Electronic properties of silicon-carbon and silicon-sodium binary clusters, produced by laser vaporization, were investigated by photoelectron spectroscopic or photoionization spectroscopic method. The photoelectron spectra of the C1Sim-1- clusters are similar to those of pure Sim- clusters in the peak positions and their envelopes, which is attributed to the similar electronic structure of Si and C atoms, leading to a similar geometry. In contrast, the similarity in the photoelectron spectra is not observed between Cn- and Cn-1Si1 clusters, which is attributed to a change in their geometry; from chain to ring.

The ionization energies (Ei) of the SinNam clusters (l≤n≤15) were determined from the threshold energy of their ionization efficiency curves. The clear parallelism between the ionization energy of SinNa and the electron affinity (EA) of Sin is found; there are three local minima at n=4, 7 and 10. This implies the facts that (1) the structure of the SinNa clusters keeps the frame of the corresponding Sin cluster unchanged and that (2) the parentage of singly occupied molecular orbital (SOMO) of SinNa is the LUMO of Sin. Furthermore, the EAs of SinNa (4≤n≤7) were determined from the threshold energy in the photoelectron spectra of SinNa". When the EAs of SinNa are compared with those of Sin, the EAs decrease at n=4-6, but the EA increases at n=7. The results of ab initio calculation show that the Na atom is bound by two Si atoms (bridge site) at n=4-6, whereas it is bound by one Si atom (apex site) at n=7.

Histamine H1-receptor antagonists with immunomodulating activities: potential use for modulating T helper type 1 (Th1)/Th2 cytokine imbalance and inflammatory responses in allergic diseases

Being a first-line treatment for hypersensitivity allergic disease, histamine H1-receptor antagonists possess anti-inflammatory activity in addition to being H1-receptor antagonists. While it is not purely a histamine-related condition, hypersensitivity allergic disease is associated with an increase in the number of T helper type 2 (Th2) cells and Th2 cytokines, and a decrease in the number of Th1 cells and Th1 cytokines. Suppression of Th2-type cytokine production in addition to H1-receptor blockade may therefore represent a successful therapeutic strategy for the treatment of hypersensitivity allergic diseases. H1-receptor antagonists have been reported to modulate immune cascade at various points by acting on T cell-related inflammatory molecules, including adhesion molecules, chemokines and inflammatory cytokines. These effects of H1-receptor antagonists may be optimized for the treatment of allergic diseases. Besides their ability to regulate inflammatory molecules, some H1-receptor antagonists have been reported to down-regulate Th2 cytokine production. In particular, it has been shown that several H1-receptor antagonists specifically inhibit the production of Th2, but not Th1, cytokines. Accumulating evidence indicates a crucial role for Th1/Th2 cytokine imbalance on the development of allergic diseases. Accordingly, the use of H1-receptor antagonist with Th2 cytokine inhibitory activity to modulate Th1/Th2 cytokine imbalance might be a favourable strategy for the treatment of hypersensitivity allergic diseases. Furthermore, the identification of H1-receptor antagonists which possess immunoregulatory activities in addition to their anti-histamine activity will provide an important insight into the development of novel immunoregulatory drugs.

Therapeutic hypothermia can be induced and maintained using either commercial water bottles or a "phase changing material" mattress in a newborn piglet model

BACKGROUND

Therapeutic hypothermia, a safe and effective treatment for neonatal encephalopathy in an intensive care setting, is not available in low-resource settings. Aims/

METHODS

To assess two low-tech, low-cost cooling devices for use in low-resource settings: (i) commercially available water bottles filled with tepid water (25 degrees C); (ii) a mattress made of phase changing material (PCM) with a melting point of 32 degrees C (PCM works as a heat buffer at this temperature). Eleven anaesthetised newborn piglets were studied following transient hypoxia-ischaemia. The cooling device was applied 2-26 h after hypoxia-ischaemia with a target rectal temperature (T(rectal)) of 33-34 degrees C. T(rectal) undershoot was adjusted using cotton blankets; the cooling device was renewed when T(rectal) rose above 35 degrees C. T(rectal) data during cooling were dichotomised (within or without target) to assess: (a) the total period within the target T(rectal) range; (b) the stability and fluctuation of T(rectal) during cooling.

RESULTS

Therapeutic hypothermia was achieved with both water bottles (n = 5) and the PCM mattress (n = 6). The mean (SD) time to reach target T(rectal) was 1.8 (0.5) h with water bottles and 1.9 (0.3) h with PCM. PCM cooling led to a longer period within the target T(rectal) range (p<0.01) and more stable cooling (p<0.05). Water bottle cooling required device renewal (in four out of five piglets).

CONCLUSION

Simple, low-tech cooling devices can induce and maintain therapeutic hypothermia effectively in a porcine model of neonatal encephalopathy, although frequent fine tuning by adjusting the number of blankets insulating the piglet was required to maintain a stable temperature. PCM may induce more stable cooling compared with water bottles.

Arachidonic acid and docosahexaenoic acid supplementation increases coronary flow velocity reserve in Japanese elderly individuals

BACKGROUND

Arachidonic acid (ARA) and docosahexaenoic acid (DHA) are important components of phospholipids and cell membranes. There has, however, been no clinical report on the direct effects of ARA and DHA on coronary circulation.

OBJECTIVE

To evaluate the effects of ARA and DHA on coronary circulation using the measurement of coronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography (TTDE).

METHODS

A double-blind, placebo-matched study of 28 Japanese elderly individuals (19 men, mean age 65 years) conducted to compare the effects of polyunsaturated fatty acids (PUFA; ARA 240 mg/day, DHA 240 mg/day) and placebo on CFVR. Coronary flow velocity (CFV) of the left anterior descending coronary artery was measured at rest and during hyperaemia by TTDE to determine CFVR.

RESULTS

There were no significant differences in CFV at rest or during hyperaemia in CFVR at baseline in the two groups (PUFA versus placebo 17 (7 SD) versus 16 (6), 62 (20) versus 59 (12), and 3.85 (1.04) versus 3.98 (0.83) cm/s, respectively). After three months' supplementation, CFV during hyperaemia was significantly higher in the PUFA than in the placebo group (73 (19) versus 64 (12) cm/s, p<0.01) although no significant difference was found between the two groups in CFV at rest (17 (7) versus 16 (4) cm/s). CFVR thus significantly increased after PUFA consumption (3.85 (1.04) versus 4.46 (0.95), p = 0.0023).

CONCLUSION

Three months' supplementation of PUFA increased CFVR in Japanese elderly individuals, which suggests beneficial effects of PUFA on the coronary microcirculation.

One-dimensional beam ordering of protons in a storage ring

The ordering of protons has been observed at a new storage ring, S-LSR, at Kyoto University. Abrupt jumps in the momentum spread and the Schottky noise power were observed for protons for the first time at a particle number of approximately 2000, upon applying electron cooling with electron currents of 25, 50, and 100 mA. The transition temperature was 0.17 and 1 meV in the longitudinal and transverse directions, respectively. The transverse temperature of the proton beam was much below that of electrons at the transition, which played an essential role in the ordering of protons.

Delayed L-DOPA-induced hyperalgesia

Previously we reported on L-DOPA's antinociceptive effect on substance P-induced nociceptive behaviors in mice [Shimizu T, Iwata S, Morioka H, Masuyama T, Fukuda T, Nomoto M. Antinociceptive mechanism of L-DOPA. Pain 2004;110;246-9.]. Since significant hyperalgesia was noted following antinociception, our study was designed to investigate the mechanism of this hyperalgesia. Nociceptive behaviors were enhanced 2 h after L-DOPA administration. L-DOPA induced hyperalgesia occurred after conversion to dopamine because co-administration of benserazide, a DOPA decarboxylase inhibitor, completely abolished the L-DOPA-induced hyperalgesia. The D2 receptor agonist, quinpirole, depressed these behaviors entirely, while the D1 antagonist, SCH23390, inhibited the enhancement of these behaviors by L-DOPA. The D2 receptor antagonist, sulpiride, which induced hyperalgesia of the substance P-induced behaviors in naive mice, did not have any effects on L-DOPA-induced hyperalgesia. Spinal cord dopamine content increased rapidly after L-DOPA administration, exhibiting levels 100 times greater than baseline, and then returned to control after 1 h. These results suggested that the dopaminergic inhibitory system for pain sensation was temporarily impaired by excess amounts of exogenous dopamine that were derived from L-DOPA and both D1 and D2 receptors were involved in L-DOPA-induced hyperalgesia.

Crk-associated substrate lymphocyte type regulates transforming growth factor-beta signaling by inhibiting Smad6 and Smad7

Crk-associated substrate lymphocyte type (Cas-L) is a 105 kDa docking protein with diverse functional properties, including regulation of cell division, proliferation, migration and adhesion. Cas-L is also involved in beta1 integrin- or antigen receptor-mediated signaling in B and T cells. In the present study, we demonstrate that Cas-L potentiates transforming growth factor-beta (TGF-beta) signaling pathway by interacting with Smad6 and Smad7. Immunoprecipitation experiments reveal that single domain deletion of full-length Cas-L completely abolishes its docking function with Smad6 and Smad7, suggesting that the natural structure of Cas-L is necessary for its association with Smad6 and Smad7. On the other hand, both N-terminal and C-terminal deletion mutants of Smad6 and Smad7 still retain their docking ability to Cas-L, suggesting that Smad6 and Smad7 possess several binding motifs to Cas-L. Moreover, Cas-L interaction with Mad-homology (MH)2 domain, but not with MH1 domain of Smad6 or Smad7, ameliorates TGF-beta-induced signaling pathway. Finally, depletion of Cas-L by small-interfering RNA oligo attenuates TGF-beta-induced growth inhibition of Huh-7 cells, with a concomitant reduction in phosphorylation of Smad2 and Smad3. These results strongly suggest that Cas-L is a potential regulator of TGF-beta signaling pathway.

Double-blind comparative study on the care of the neonatal umbilical cord using 80% ethanol with or without chlorhexidine

We conducted a double-blind comparative study on the effectiveness of 80% ethanol (EtOH), with or without chlorhexidine (CHD), in the prevention of neonatal umbilical colonization by Staphylococcus aureus, the most frequently isolated pathogen on the neonatal umbilicus in the early period. A total of 100 neonates born at the National Tokyo Medical Centre from March to May 2000 and nursed at a maternity ward were enrolled. Forty-eight were randomly allocated to the group for whom umbilical cord disinfection was performed using 80% EtOH containing 0.5% CHD (CHD group) and 52 to disinfection with 80% EtOH alone (EtOH group). The mothers of the neonates and the nursing staff were unaware as to which disinfectant was being used. Disinfection of the umbilicus and the surrounding area was done immediately after birth and twice daily thereafter, after bathing and in the evening, throughout the hospitalization period. Specimens for bacterial culture were taken from the umbilical cord and surrounding skin on day 4 or 5 after birth. As a disinfectant susceptibility test, we checked the minimum killing concentration (MKC) of CHD and EtOH. There was no statistically significant difference between the two groups with respect to sex, gestation period, birthweight, APGAR score or delivery method. In the CHD group, S. aureus was isolated from 25% of the patients, while it was isolated from 57.7% in the EtOH group (P<0.001). In the CHD group, 50% of the S. aureus strains were MRSA, compared with 73.3% in the EtOH group (non-significant). All the S. aureus strains were killed by the combination of both CHD and EtOH at the concentrations used. In terms of the MKC90, there was no significant difference between the CHD group and the EtOH group. For the daily care of the neonatal umbilicus, disinfection using 80% EtOH containing CHD was found to be more effective than that using 80% EtOH alone in preventing colonization by S. aureus.

The tetraspanin CD9 is preferentially expressed on the human CD4(+)CD45RA+ naive T cell population and is involved in T cell activation

Human CD4+ T cells can be divided into reciprocal memory and naive T cell subsets based on their expression of CD45 isoforms and CD29/integrin beta1 subunit. To identify unique cell surface molecules on human T cells, we developed a new monoclonal antibody termed anti5H9. Binding of anti5H9 triggers a co-stimulatory response in human peripheral blood T cells. Retrovirus-mediated expression cloning has revealed that the antigen recognized by anti5H9 is identical to the tetraspanin CD9. We now show that human CD9 is preferentially expressed on the CD4(+)CD45RA+ naive T cell subset, and that CD9(+)CD45RA+ T cells respond preferentially to the recombinant beta2-glycoprotein I, compared to CD9-CD45RA+ T cells. Furthermore, anti5H9 inhibits both the recombinant beta2-glycoprotein I- and the recall antigen tetanus toxoid-specific T cell proliferation. These results suggest that the tetraspanin CD9 plays an important role in T cell activation.

Ebastine inhibits T cell migration, production of Th2-type cytokines and proinflammatory cytokines

BACKGROUND

Cytokine imbalance and cellular migration to inflammatory sites are critical components of allergic diseases. Redirecting cytokine imbalance and inhibiting cell migration therefore represent important therapeutic strategies for the treatment of these disorders.

OBJECTIVES

To study the in vitro effect of ebastine, a novel non-sedating H1 receptor antagonist, on cytokine secretion and migration of activated T cells, as well as production of pro-inflammatory cytokines by macrophages.

METHODS

Peripheral T cells obtained from healthy volunteers were cultured in wells coated with the combination of anti-CD3 monoclonal antibody (mAb) and anti-CD26 mAb, anti-CD3 mAb and anti-CD28 mAb, or anti-CD3 mAb with PMA, in the presence or absence of ebastine. T cell proliferation and the production of cytokines were measured by [3H]thymidine incorporation assay and ELISA, respectively. In addition, transendothelial migration of T cells and production of pro-inflammatory cytokines by macrophages were examined.

RESULTS

Ebastine inhibited T cell proliferation and the production of IL-4, IL-5, IL-6, and TNF-alpha by T cells under each co-stimulatory condition tested, whereas it exhibited no effect on the production of IL-2 or IFN-gamma. In addition, T cell migration and the production of such pro-inflammatory cytokines as TNF-alpha and IL-6 by macrophages were inhibited by ebastine.

CONCLUSIONS

These results indicate that ebastine has a specific inhibitory effect on Th2-type cytokine production. Moreover, ebastine inhibited T cell migration and pro-inflammatory cytokine production by T cells and macrophages, suggesting that ebastine might be useful for the treatment of T cell-mediated allergic inflammatory disorders, including asthma, atopic dermatitis, and Th2-type autoimmune diseases.

Prooxidant action of gallic acid compounds: copper-dependent strand breaks and the formation of 8-hydroxy-2'-deoxyguanosine in DNA

Gallic acid and its alkylesters, polyphenolic compounds with antioxidative activity, acted as a prooxidant causing a copper-dependent DNA damage. Treatment of DNA from plasmid pBR322 and calf thymus with gallic acid plus copper ion caused strand scission and the formation of 8-hydroxy-2'-deoxyguanosine in DNA. Addition of catalase protected DNA from the gallic acid/copper-dependent strand breaks and the formation of 8-hydroxy-2'-deoxyguanosine, indicating that hydroxyl radical may participate in the DNA damage. Ethyl-, propyl- and butylgallates showed only a little DNA damage. Octyl- and laurylgallates caused negligible damage of DNA. DNA strand breaks and formation of 8-hydroxy-2'-deoxyguanosine were closely related to the reduction of copper by gallate compounds. These results imply that cuprous ion reduced by gallate derivatives may play a key role in the oxidative cleavage of DNA and the formation of base adduct. The cytotoxic effect of gallate compounds can be explained by their prooxidant action dependent on the reducing activity.

Surgical clipping of basilar aneurysms: relationship between the different approaches and the surgical corridors

BACKGROUND

Surgical clipping for basilar artery aneurysm (BAA) is a technically demanding procedure due to the depth of the surgical field and the presence of vital perforating arteries in the vicinity. The incorporation of various modifications in the conventional approaches has expanded the surgical armamentarium in dealing with these difficult lesions.

METHODS AND FINDINGS

87 patients of BAA were operated at our center, out of which in 48 patients, a pterional transsylvian approach was used. In 12 patients, this approach had to be extended to incorporate the anterior temporal approach in 6 cases, transzygomatic subtemporal approach in 2 cases and transcavernous approach in 4 cases. The surgical indications for the additional approaches and the relationships between the surgical corridors gained by their inclusion were studied. The use of neuroendoscopy facilitated adequate clipping in one case of high BAA without the incorporation of bone drilling, thus opening new surgical corridors.

INTERPRETATION

The variable situation of the BAA makes it mandatory for the surgeon to be prepared to simultaneously work through multiple surgical corridors. Neuroendoscopic-assisted microneurosurgery occasionally utilizes a narrow surgical corridor to facilitate BAA clipping using the conventional approaches and eliminates the need to gain access using additional surgical corridors.

Modulation of intracellular glutathione concentration alters dehydropyrimidine dehydrogenase activity in peripheral blood mononuclear cells

Dehydropyrimidine dehydrogenase (DPD) is the initial key enzyme in the regulation of 5-fluorouracil catabolism and thus controls availability of 5-fluorouracil for anabolism. Modulation of DPD activity may increase the antitumor effect and avoid toxic side effects in 5-fluo-rouracil-based chemotherapy. We measured DPD activity in peripheral blood mononuclear cells from cancer patients and simultaneously monitored intracellular glutathione (GSH) and plasma GSH levels. There was a significant linear relationship between DPD activity and intracellular GSH levels in peripheral blood mononuclear cells obtained from cancer patients. Suppression of intracellular GSH level by buthionine sulfoximine decreased DPD activity, while enhancement of intracellular GSH level by 2-mercaptoethanol increased DPD activity. This study indicated that alteration of intracellular GSH concentration may modulate DPD activity.

Enamel tensile bond strength and morphology of resin-enamel interface created by acid etching system with or without moisture and self-etching priming system

The purpose of this study was to estimate the effect of three types of different adhesive systems on enamel adhesion. Scotchbond Multi-Purpose (MP) as a traditional system, Single Bond (SB) as a wet-bonding system and Clearfil SE Bond (SE) and Unifil Bond (UB) as self-etching priming systems were used. Bovine enamel was treated with each system and tensile bond strength (TBS) of resin to the enamel was measured. The conditioned enamel surfaces and resin-enamel interfaces were also morphologically observed with scanning electron microscope (SEM). The mean TBS for MP, SB, SE and UB were 15.3, 13.7, 14.3 and 11.6 MPa, respectively. There was no significant difference in mean TBS among all products but the traditional system showed the most stable TBS. In SEM observations, self-etching primer created a weaker etched pattern on the enamel surface than phosphoric acid. At the resin-enamel interfaces, thick tag-like extensions penetrated into the enamel etched with phosphoric acid regardless of using the wet-bonding technique, while self-etching primer created thin lamina-like resin penetrations. These results indicate that the traditional system with phosphoric acid etching exhibits the most stable enamel adhesion although the enamel-bonding promoting abilities of these adhesive systems are equivalent to each other.

Treatment of unruptured intracranial aneurysms--a clinicopathological correlation

OBJECT

Brain check-up is very important for detecting the incidence and prevalence of aneurysms in the population and to get the definite strategy for the treatment of intracranial aneurysms.

METHODS

This is a retrospective study of 116 aneurysms detected by brain check-up between 1998-1999 which were treated either by clipping or endovascular coiling. In some cases the aneurysmal wall was resected for histopathological examination and compared with five normal autopsy cases.

CONCLUSIONS

Direct surgery is the primary option for a patient with an aneurysm in the anterior circulation especially in young patients. Intravascular therapy is suitable for aneurysms in the posterior circulation and in intracavernous site.

Soluble CD26/dipeptidyl peptidase IV induces T cell proliferation through CD86 up-regulation on APCs

CD26 is a T cell costimulatory molecule with dipeptidyl peptidase IV enzyme activity in its extracellular region. We have previously reported that the addition of soluble CD26 (sCD26) resulted in enhanced proliferation of peripheral blood T lymphocytes induced by the recall Ag, tetanus toxoid (TT). However, the mechanism involved in this immune enhancement has not yet been elucidated. In this paper, we demonstrate that the enhancing effect of sCD26 on TT-induced T cell proliferation occurred in the early stages of immune response. The cells directly affected by exogenously added sCD26 are the CD14-positive monocytes in the peripheral blood. Mannose-6 phosphate interfered with the uptake of sCD26 into monocytes, suggesting that mannose-6 phosphate/insulin-like growth factor II receptor plays a role in the transportation of sCD26 into monocytes. When sCD26 was added after Ag presentation had taken place, enhancement in TT-induced T cell proliferation was not observed. In addition, enhancement of TT-mediated T cell proliferation by sCD26 does not result from trimming of the MHC-bound peptide on the surface of monocytes. Importantly, we also showed that exogenously added sCD26 up-regulated the expression of the costimulatory molecule CD86 on monocytes through its dipeptidyl peptidase IV activity, and that this increased expression of CD86 was observed at both protein and mRNA level. Therefore, our findings suggest that sCD26 enhances T cell immune response to recall Ag via its direct effect on APCs.

Novel marine-derived halogen-containing gramine analogues induce vasorelaxation in isolated rat aorta

We examined the effects of 2,5,6-tribromo-1-methylgramine (TBG), isolated from bryozoan, and its derivative, 5,6-dibromo-1,2-dimethylgramine (DBG), on the contraction of rat aorta. TBG and DBG decreased the high-K(+)-induced increase in muscle contraction and cytosolic Ca(2+) level ([Ca(2+)](i)), respectively. The inhibitory effects of TBG and DBG on high-K(+)-induced contraction were antagonized by increasing the external Ca(2+) concentration or by 1,4-dihydro2,6-dimethyl-5-nitro-4-[2-(trifluoromethyl)phenyl]pyridine-3-carboxylic acid (Bay k8644). The high-K(+)-induced increase of Mn(2+) influx was completely blocked by 10 microM TBG or 10 microM DBG. In the Ca(2+)-free solution, 30 microM TBG or 30 microM DBG inhibited the phenylephrine-induced transient increase in [Ca(2+)](i) and muscle tension, while scarcely affecting caffeine-induced transient changes. TBG and DBG significantly increased the cyclic AMP content at 30 microM, but not at 10 microM. These results suggest that TBG and DBG inhibit the smooth muscle contraction by inhibiting Ca(2+) entry, and at higher concentrations, the increase in intracellular cyclic AMP content also contributes to their inhibitory effect.

Application of 2-(3,5,6-trifluoro-2-hydroxy-4-methoxyphenyl)benzoxazole and -benzothiazole to fluorescent probes sensing pH and metal cations

2-(3,5,6-Trifluoro-2-hydroxy-4-methoxyphenyl)benzoxazole (3) and benzothiazole analogue (4) are prepared by the two-step procedures from the corresponding 2-(pentafluorophenyl)benzazoles. Benzoxazole 3 is applicable to a fluorescent probe sensing magnesium cation, and 4 is suitable for sensing zinc cation. Both fluorophores 3 and 4 are sensitive to the pH change at pH 7-8, resulting in large fluorescence enhancement under basic conditions. Their high sensitivity to pH and selectivity in metal cations are ascribed to the high acidity of the fluorophenol moiety.

[The trend of childhood bacterial meningitis in Japan (1997.7-2000.6)]

We surveyed the epidemiology of purulent meningitis in pediatrics for 3 years between July 1997 and June 2000 in Japan and obtained the following results. The number of cases of purulent meningitis was 428, which was equivalent of 1.1-1.7 children out of 1,000 hospitalized those in pediatrics per year. The age-distribution for the infections was the highest under 1 year of age and it decreased as the age increased. Under 1 year of age, the highest distribution was observed in one month of age and under 1 month of age, the highest distribution was observed in 7 days of or younger ages. Haemophilus influenzae was the most common pathogen causing the infections, followed by Streptococcus pneumoniae, group B streptococcus, and Escherichia coli. Relationship between causing pathogens and age-distribution was as follows: group B streptococcus and E. coli were major pathogens under 4 months of age and H. influenzae and S. pneumoniae were major pathogens over 3 months of age. Susceptibility tests performed at each facility demonstrated that 25.3% of H. influenzae isolates and 38.7% of S. pneumoniae isolates were drug-resistant. Analysis of resistant genes for H. influenzae and S. pneumoniae isolates, which were stored and sent, demonstrated higher rates of resistance than those observed in susceptibility tests. These results suggest that the increase in insufficient efficacy of usual treatment with combination of ampicillin and cefotaxime is predictable against the infections. Therefore, the treatment for the infections should be reconsidered.

Macular fold after limited macular translocation treated with scleral shortening release and intravitreal gas

PURPOSE

To describe a case developing a macular fold as a complication of limited macular translocation, which was successfully managed without repeat vitrectomy.

METHODS

Interventional case report. A 34-year-old woman who underwent limited macular translocation for subfoveal choroidal neovascularization secondary to myopic degeneration developed a postoperative macular fold. Her visual acuity deteriorated from 20/100 to 20/200 postoperatively.

RESULTS

She underwent scleral shortening release and intravitreal gas injection 4 days after the initial surgery and had a resolution of macular fold with adequate foveal displacement. Her visual acuity had improved to 20/40 3 months postoperatively.

CONCLUSION

Scleral shortening release and intravitreal gas injection may be considered for the management of severe macular fold caused by limited macular translocation.

Zero-birefringence polymer by the anisotropic molecule dope method

We propose using the anisotropic molecule dope method for synthesizing a zero-birefringence polymer that showed no orientational birefringence at any orientation degree of polymer chains. In this method a rodlike molecule with polarizability anisotropy was chosen to compensate orientational birefringence. The zero-birefringence polymer was synthesized by doping of 3-wt.% trans-stilbene as an anisotropic molecule into poly(methyl methacrylate). The zero-birefringence at the 590-nm wavelength in the drawn film and the injection-molded plate made from the zero-birefringence polymer was confirmed by the rotating parallel nicols method. Furthermore, high transparency (37.2 dB/km) of the zero-birefringence polymer at the 633-nm wavelength was confirmed by the light-scattering measurement.

Improved nasal absorption of drugs using poly-L-arginine: effects of concentration and molecular weight of poly-L-arginine on the nasal absorption of fluorescein isothiocyanate-dextran in rats

The effects of the concentration and molecular weight of poly-L-arginine (poly-L-Arg) on the in vivo nasal absorption of fluorescein isothiocyanate-labeled dextran (MW, 4 kDa, FD-4) in rats were studied. When poly-L-Arg with a range of different molecular weights (MW, 8.9, 45.5 and 92.0 kDa) was applied intranasally at various concentrations, the bioavailability (F(0-9 h)) of FD-4 increased with the increasing concentration of poly-L-Arg. The enhanced absorption was also dependent on the molar concentration, in that the poly-L-Arg with a higher molecular weight increased F(0-9 h) at a lower molar concentration. In addition, for each applied concentration, the poly-L-Arg exhibited a molecular weight-dependence as far as the enhancement of FD-4 absorption was concerned. On the other hand, the maximum absorption rate (MAR) of FD-4, calculated by means of a deconvolution method, tended to reach a maximum plateau level at a lower applied concentration for the poly-L-Arg with the highest molecular weight, but this plateau level was almost the same for poly-L-Arg with molecular weights of 45.5 and 92.0 kDa. Moreover, the simulated absorption profiles of FD-4 indicate that the degree of enhancement (the level of MAR and the subsequent reduction in the absorption rate) was dependent on the molecular weight of poly-L-Arg, while the effect of poly-L-Arg was maintained for a longer period, depending on the applied concentration, although the MAR was relatively similar. These results indicate that the molecular weight of poly-L-Arg appears to affect both the enhancing efficiency (absorption rate) and the time-frame of this enhancing effect, whereas the concentrations of each poly-L-Arg system applied only have an effect on the time-frame. These effects may also be associated with the charge density of a poly-L-Arg molecule.

Graph-theoretical analysis of tunneling electron transfer in large polycyclic aromatic hydrocarbon networks

Effect of a single nitrogen atom substitution to a number of large polycyclic aromatic hydrocarbon (PAH) molecules was calculated systematically, and it was found that especially in parallelogram-type PAH abnormal electron transfer (called tunneling electron transfer, TET) was observed. That is, fairly large amount of pi-electron is withdrawn to an electronegative nitrogen atom from almost the farthest end of a conjugated aromatic hydrocarbon molecule, leaving almost no change in the interior of the molecule. This change can be simulated by the Kekulé structure counting for subgraphs of the parent molecule.