Evaluating dressing materials for the prevention of shear force in the treatment of pressure ulcers

OBJECTIVE

Shear force is believed to affect pressure ulceration. Therefore, dressing materials that reduce shear force may prevent ulceration and facilitate healing.

METHOD

We measured the following three properties: the coefficient of friction between the outer layer of the dressings and the patient's clothes; the degree of adhesiveness between the inner layer of the dressing and the patient's skin; the transmissibility of shear force of the dressing.

RESULTS

The coefficients of static friction were 1.01 for hydropolymer, 0.72 for hydrofoam and 0.48 for hydrocolloid. Adhesiveness was tested by rolling different sized ball bearings down a slope and over the adhesive lining under both wet and dry conditions. Under dry conditions, the heaviest ball bearing that stopped rolling for five seconds was 111.9g for both hydrofoam and hydrocolloid. Under wet condition, it was 11.9g for hydrofoam and under 1g for hydrocolloid. Tests showed the very low transmissibility (I N buffer) of shear force for hydrofoam, with significant differences between the dressings. Clinical observation has identified good results for hydrofoam when used under highly exuding conditions and for hydrocolloid when used with relatively slight or decreased exudate.

CONCLUSION

Existing dressing materials are being developed and evaluated for wound healing. However, if innovations in the raw materials from which dressings are manufactured could lead to a reduction in shear force and the prevention of pressure ulcers, then dressing materials could be discussed from a viewpoint that is quite different from wound healing.

Chaos analysis of electro encephalography and control of seizure attack of epilepsy patients

In order to evaluate the EEG of patients with epilepsy, chaos analysis was performed for the subdural EEG time series data. The chaos attractor was reconstructed in the phase space and the correlation dimension. KS entropy calculated from the Lyapunov exponents was evaluated. Before the seizure attack, the KS entropy showed a lower value when compared with the time series data recorded during healthy condition. The results of our study suggest that it is possible to predict the seizure attack by the chaos analysis of the EEG signal. Further, we aim at developing an automatic control system for predicting a seizure attack by the use of local cooling of the focus with Peltier elements.

Experimental identification of spin-parities and single-particle configurations in 257No and its alpha-decay daughter 253Fm

alpha-gamma and alpha-electron coincidence spectroscopy for a short-lived heavy actinide nucleus (257)No (T(1/2) = 24.5 s) has been performed using a gas-jet transport system and an on-line isotope separator. Spin-parities of excited states in (253)Fm fed by the alpha decay of (257)No have been identified on the basis of the measured internal conversion coefficients. The nu3/2(+)[622] configuration has been assigned to the ground state of (257)No as well as to the 124.1 keV level in (253)Fm. It was found that the ground-state configuration of (257)No is different from that of lighter N = 155 isotones.

Long-term outcome of radial shortening with or without ulnar shortening for treatment of Kienbock's disease: a 13-25 year follow-up

Fourteen of 35 patients who underwent radial shortening with or without ulnar shortening for the treatment of Kienbock's disease were followed up for a median of 19 (range, 13-25) years. Radial shortening was performed for patients with ulnar negative or neutral variance, and combined shortening of radius and ulna for those with ulnar positive variance. Overall the clinical situation was significantly improved at the final follow-up. There was no significant advanced collapse of the wrists and Lichtman's stage of disease increased in only three cases. Although osteoarthritic changes in the distal radio-ulnar joint progressed in five patients, this may have little influence on clinical outcome. Radial shortening osteotomy is a reliable method for treatment of Kienbock's disease.

FTIR studies of internal water molecules in the Schiff base region of bacteriorhodopsin

In a light-driven proton pump protein, bacteriorhodopsin (BR), three water molecules participate in a pentagonal cluster that stabilizes an electric quadrupole buried inside the protein. Previously, low-temperature Fourier-transform infrared (FTIR) difference spectra between BR and the K photointermediate in D(2)O revealed six O-D stretches of water in BR at 2690, 2636, 2599, 2323, 2292, and 2171 cm(-)(1), while five water bands were observed at 2684, 2675, 2662, 2359, and 2265 cm(-)(1) for the K intermediate. The frequencies are widely distributed over the possible range of stretching vibrations of water, and water molecules at <2400 cm(-)(1) were suggested to hydrate negative charges because of their extremely strong hydrogen bonds. In this paper, we aimed to reveal the origin of these water bands in the K minus BR spectra by use of various mutant proteins. The water bands were not affected by the mutations at the cytoplasmic side, such as T46V, D96N, and D115N, implying that the water molecules in the cytoplasmic domain do not change their hydrogen bonds in the BR to K transition. In contrast, significant modifications of the water bands were observed for the mutations in the Schiff base region and at the extracellular side, such as R82Q, D85N, T89A, Y185F, D212N, R82Q/D212N, and E204Q. From these results, we concluded that the six O-D stretches of BR originate from three water molecules, water401, -402, and -406, involved in the pentagonal cluster. Two stretching modes of each water molecule are highly separate (300-470 cm(-)(1) for O-D stretches and 500-770 cm(-)(1) for O-H stretches), which is consistent with the previous QM/MM calculation. The small amplitudes of vibrational coupling are presumably due to strong association of the waters to negative charges of Asp85 and Asp212. Among various mutant proteins, only D85N and D212N lack strongly hydrogen-bonded water molecules (<2400 cm(-)(1)) and proton pumpimg activity. We thus infer that the presence of a strong hydrogen bond of water is a prerequisite for proton pumping in BR. Internal water molecules in such a specific environment are discussed in terms of functional importance for rhodopsins.

Sprouting from arteriovenous shunt vessels with increased blood flow

The purpose of this study was to evaluate the effect of increased blood flow on angiogenesis at the large vessels. The arteriovenous (AV) shunt was made on the thigh of male Wistar rats (n = 27) to increase blood flow, wrapped with artificial skin dermis, which consisted of a silicon outer layer, and isolated from surrounding tissues. Blood flow increased from 2.40 +/- 0.77 to 35.8 +/- 8.7 ml min(-1) (14.9 times), and the shear stress index (relative value of shear stress) increased from 10.7 +/- 3.6 to 73.4 +/- 18.1 (6.85 times) 60 min after the shunt formation. Newly formed vessels were observed around the AV shunt loop. Scanning electron micrographs at the AV shunt vessel lumen showed modified endothelial cells at day 7 and a remarkable number of pores at day 14. The volume of newly formed vessels was increased 12 times from day 5 to day 14. The mechanical factor of shear stress was considered the major stimulator of angiogenesis. This is the first report of electron-microscopic observation of sprouts from a large vessel lumen. The new AV shunt model is useful for basic research on angiogenesis at the large vessels in vivo and, furthermore, could generate vascularised tissues with various cultured cells.

Preparation of a liquid nitrogen target for measurement of γ-rays in the 14N(, )15N reaction as an intensity standard in energy regions up to 11MeV

We have developed a liquid nitrogen (N(2)) target that allows us to clearly measure gamma-rays below 2 MeV and to improve neutron beam availability. The intensity of the prompt 2223 keV gamma-ray from the (1)H(n, gamma) reaction in the present target could be reduced to about 160 in comparison with the one in the commercially available melamine (C(3)H(6)N(6)) target. The statistics of the full-energy-peak counts were improved by factors of 15-30 and about 4 in the energy regions below and above 2 MeV, respectively.

The influence of age on apoptotic and other mechanisms of cell death after cerebral hypoxia-ischemia

Unilateral hypoxia-ischemia (HI) was induced in C57/BL6 male mice on postnatal day (P) 5, 9, 21 and 60, corresponding developmentally to premature, term, juvenile and adult human brains, respectively. HI duration was adjusted to obtain a similar extent of brain injury at all ages. Apoptotic mechanisms (nuclear translocation of apoptosis-inducing factor, cytochrome c release and caspase-3 activation) were several-fold more pronounced in immature than in juvenile and adult brains. Necrosis-related calpain activation was similar at all ages. The CA1 subfield shifted from apoptosis-related neuronal death at P5 and P9 to necrosis-related calpain activation at P21 and P60. Oxidative stress (nitrotyrosine formation) was also similar at all ages. Autophagy, as judged by the autophagosome-related marker LC-3 II, was more pronounced in adult brains. To our knowledge, this is the first report demonstrating developmental regulation of AIF-mediated cell death as well as involvement of autophagy in a model of brain injury.

Strongly hydrogen-bonded water molecules in the Schiff base region of rhodopsins

In many rhodopsins, a positively charged retinal chromophore is stabilized by a negatively charged carboxylate, and the presence of bound water molecules has been found in the Schiff base region by X-ray crystallography of various rhodopsins. Low-temperature Fourier-transform infrared (FTIR) spectroscopy can directly monitor hydrogen-bonding alterations of internal water molecules of rhodopsins. In particular, we found that a bridged water molecule between the Schiff base and Asp 85 in bacteriorhodopsin (BR), a light-driven proton-pump protein, forms an extremely strong hydrogen bond. It is likely that a hydration switch of the water from Asp 85 to Asp 212 plays an important role in the proton transfer in the Schiff base region of BR. Comprehensive studies of archaeal and visual rhodopsins have revealed that strongly hydrogen-bonded water molecules are only found in the proteins exhibiting proton-pump activities. Strongly hydrogen-bonded water molecules and its transient weakening may be essential for the proton-pump function of rhodopsins.

Prognostic index of liver cirrhosis with ascites with and without hepatocellular carcinoma

BACKGROUND

In Japan, the incidence of liver cirrhosis caused by hepatitis viruses is higher, and cirrhosis is more likely to be complicated by hepatocellular carcinoma, than in Western countries. The aim of this study was to predict the outcome in liver cirrhosis with ascites with and without hepatocellular carcinoma.

METHODS

The subjects were 146 patients with liver cirrhosis complicated by ascites. Forty-six factors were evaluated concerning clinical laboratory parameters and extracted prognostic factors using the Cox proportional hazards model.

RESULTS

The mean duration of the follow-up period was 634.9 days, during which 89 (61%) of the patients died, 27 (18.5%) survived, and 30 (20.6%) were lost to follow-up. The cumulative survival rate after the onset of ascites was 59.7% after 1 year, 44.5% after 2 years, and 29.5% after 5 years. Multivariate analysis indicated 9 factors, i.e. age, total bilirubin (T-Bil), alkaline phosphatase (ALP), blood urea nitrogen (BUN), alpha-fetoprotein (AFP), mean arterial pressure (MAP), gastrointestinal bleeding, infection, and portal vein tumor thrombosis (PVTT), as independent prognostic factors. The prognostic index (PI) was calculated by the following formula using these 9 factors. PI = 0.045 x age + 0.180 x T-Bil + 0.088 x ALP + 0.020 x BUN + 0.467 x AFP + (-0.022 x MAP) + 0.662 x gastrointestinal bleeding + 0.521 x infections + 0.882 x PVTT.

CONCLUSION

Prediction of the outcome using PI based on the 9 factors provides additional information for the determination of the therapeutic approach in cirrhotic patients with ascites with and without hepatocellular carcinoma.

Altered hydrogen bonding of Arg82 during the proton pump cycle of bacteriorhodopsin: a low-temperature polarized FTIR spectroscopic study

Light-driven proton transport in bacteriorhodopsin (BR) is achieved by dynamic rearrangement of the hydrogen-bonding network inside the membrane protein. Arg82 is located between the Schiff base region and proton release group, and has a major influence on the pK(a) values of these groups. It is believed that Arg82 changes its hydrogen-bonding acceptors during the pump cycle of BR, stages of which are correlated with proton movement along the transport pathway. In this study, we compare low-temperature polarized FTIR spectra of [eta(1,2)-(15)N]arginine-labeled BR in the 2750-2000 cm(-1) region with those of unlabeled BR for the K, L, M, and N intermediates. In the K-minus-BR difference spectra, (15)N-shifted modes were found at 2292 (-)/2266 (+) cm(-1) and at 2579 (-)/2567 (+) cm(-1). The former corresponds to strong hydrogen bonding, while the latter corresponds to very weak hydrogen bonding. Both N-D stretches probably originate from Arg82, the former oriented toward water 406 and the latter toward the extracellular side, and both hydrogen bonds are somewhat strengthened upon retinal photoisomerization. This perturbation of arginine hydrogen bonding is entirely relaxed in the L intermediate where no (15)N-isotope shifts are observed in the difference spectrum. In the M intermediate, the frequency is not significantly altered from that in BR. However, the polarized FTIR spectra strongly suggest that the dipolar orientation of the strongly hydrogen bonded N-D group of Arg82 is changed from perpendicular to parallel to the membrane plane. Such a change is presumably related to the motion of the Arg82 side chain from the Schiff base region to the extracellular proton release group. Additional bands corresponding to weak hydrogen bonding were observed in both the M-minus-BR and N-minus-BR spectra. Changes in hydrogen-bonding structures involving Arg82 are discussed on the basis of these FTIR observations.

Observation by an air-shower array in Tibet of the multi-TeV cosmic-ray anisotropy due to terrestrial orbital motion around the Sun

We report on the solar diurnal variation of the galactic cosmic-ray intensity observed by the Tibet III air shower array during the period from 1999 to 2003. In the higher-energy event samples (12 and 6.2 TeV), the variations are fairly consistent with the Compton-Getting anisotropy due to the terrestrial orbital motion around the Sun, while the variation in the lower-energy event sample (4.0 TeV) is inconsistent with this anisotropy. This suggests an additional anisotropy superposed at the multi-TeV energies, e.g., the solar modulation effect. This is the highest-precision measurement of the Compton-Getting anisotropy ever made.

Autoantibodies from primary biliary cirrhosis patients with anti-p95c antibodies bind to recombinant p97/VCP and inhibit in vitro nuclear envelope assembly

We have reported previously that p95c, a novel 95-kDa cytosolic protein, was the target of autoantibodies in sera of patients with autoimmune hepatic diseases. We studied 30 sera that were shown previously to immunoprecipitate a 95 kDa protein from [(35)S]-methionine-labelled HeLa lysates and had a specific precipitin band in immunodiffusion. Thirteen sera were available to test the ability of p95c antibodies to inhibit nuclear envelope assembly in an in vitro assay in which confocal fluorescence microscopy was also used to identify the stages at which nuclear assembly was inhibited. The percentage inhibition of nuclear envelope assembly of the 13 sera ranged from 7% to 99% and nuclear envelope assembly and the swelling of nucleus was inhibited at several stages. The percentage inhibition of nuclear assembly was correlated with the titre of anti-p95c as determined by immunodiffusion. To confirm the identity of this autoantigen, we used a full-length cDNA of the p97/valosin-containing protein (VCP) to produce a radiolabelled recombinant protein that was then used in an immunoprecipitation (IP) assay. Our study demonstrated that 12 of the 13 (93%) human sera with antibodies to p95c immunoprecipitated recombinant p97/VCP. Because p95c and p97 have similar molecular masses and cell localization, and because the majority of sera bind recombinant p97/VCP and anti-p95c antibodies inhibit nuclear assembly, this is compelling evidence that p95c and p97/VCP are identical.

Physiological studies on vasoactive intestinal peptide in rat small bowel isografts

BACKGROUND

Vasoactive intestinal peptide (VIP) is released by stimulation of nonadrenergic noncholinergic (NANC) inhibitory nerves. In order to evaluate the function of VIP in jejunal isografts, we examined the enteric nerve responses in isografted rat jejunum compared with normal jejunum.

METHODS

Orthotopic entire small bowel transplantation (SBT) with portocaval drainage was performed from Lewis rats to Lewis rats. Grafted tissue specimens were obtained 130 days after SBT (n = 8). As controls, normal segments of the jejunum were obtained from nontransplanted Lewis rats (n = 20). A mechanograph was used to evaluate in vitro jejunal responses to electrical field stimulation (EFS) of the adrenergic and cholinergic nerves before and after treatment with various autonomic nerve blockers and VIP.

RESULTS

The isografted jejunum was more strongly innervated by excitatory nerves, especially NANC excitatory nerves, than the normal jejunum (P <.05). VIP mediated relaxation reactions of NANC inhibitory nerves in the normal but to a lesser extent in the isografted jejunum (P <.05).

CONCLUSIONS

The increased NANC excitatory nerves and the decreased effects of VIP in mediating NANC inhibitory nerves may largely relate to the peristaltic abnormalities seen in the isografted LEW rat jejunum.

Delayed grafting of BDNF and NT-3 producing fibroblasts into the injured spinal cord stimulates sprouting, partially rescues axotomized red nucleus neurons from loss and atrophy, and provides limited regeneration

Ex vivo gene therapy, utilizing modified fibroblasts that deliver BDNF or NT-3 to the acutely injured spinal cord, has been shown to elicit regeneration and recovery of function in the adult rat. Delayed grafting into the injured spinal cord is of great clinical interest as a model for treatment of chronic injury but may pose additional obstacles that are not present after acute injury, such as the need to remove an established scar, increased retrograde cell loss and/or atrophy, and diminished capacity for regeneration by neurons which may be doubly injured. The purpose of the present study was to determine if delayed grafting of neurotrophin secreting fibroblasts would have anatomical effects similar to those seen in acute grafting models. We grafted a mixture of BDNF and NT-3 producing fibroblasts or control fibroblasts into a complete unilateral cervical hemisection after a 6-week delay. Fourteen weeks after delayed grafting we found that both the neurotrophin secreting fibroblasts and control fibroblasts survived, but that only the neurotrophin secreting grafts provided a permissive environment for host axon growth, as indicated by immunostaining for RT-97, a marker for axonal neurofilaments, GAP-43, a marker for elongating axons, CGRP, a marker for dorsal root axons, and 5-HT, a marker for raphe spinal axons, within the graft. Anterograde tracing of the uninjured vestibulospinal tract showed growth into neurotrophin producing transplants but not into control grafts, while anterograde tracing of the axotomized rubrospinal tract showed a small number of regenerating axons within the genetically modified grafts, but none in control grafts. The neurotrophin expressing grafts, but not the control grafts, significantly reduced retrograde degeneration and atrophy in the injured red nucleus. Grafts of BDNF + NT-3 expressing fibroblasts delayed 6 weeks after injury therefore elicit growth from intact segmental and descending spinal tracts, stimulate modest regenerative growth by rubrospinal axons, and partially rescue axotomized supraspinal neurons and protect them from atrophy. The regeneration of rubrospinal axons into delayed transplants was much less than has been observed when similar transplants were placed acutely into a lateral funiculus or, after a 4-week delay, into a hemisection lesion. This suggests that the regenerative capacity of chronically injured red nucleus neurons was markedly diminished. The increased GAP43 reactivity in the corticospinal tracts ipsilaterally and contralaterally to the combination grafts suggests that these axons remain responsive to the neurotrophins, that the neurotrophins may stimulate both regenerative and sprouting responses, and that the grafted cells continue to secrete the neurotrophins.

Water Molecules in the Schiff Base Region of Bacteriorhodopsin

The Schiff base region of bacteriorhodopsin (BR), a light-driven proton pump, contains a pentagonal cluster, being composed of three water molecules and one oxygen each of Asp85 and Asp212. Asp85 and Asp212 are located at similar distances from the retinal Schiff base, whereas the Schiff base proton is transferred only to Asp85 during the pump function. The present FTIR study experimentally established the stretching vibration of water402 hydrating with Asp85 by use of various BR mutants, whose frequency (2171 cm-1 as the O-D stretch) indicates very strong hydrogen bond.

Primary motor cortex stimulation within the central sulcus for treating deafferentation pain

Nine patients with post-stroke pain, six with brachial plexus injuries, two with phantom limb pain, one with spinal cord injury, and one with brain stem injury were treated with a modified motor cortex stimulation (MCS) protocol. Preoperative pharmacological tests were performed with phentolamine, lidocaine, ketamine, thiopental, morphine, and placebo. We placed a grid electrode in the subdural space to decide upon the best stimulation point for pain relief over a few weeks with the purpose of determining the placement of a Resume electrode. In five patients, Resumes were implanted in the interhemispheric fissure to reduce lower extremity pain. In five other patients, Resumes were placed within the central sulcus to stimulate area 4 and area 3b. In addition, electrodes were also placed on the surface of the precentral gyrus. Fourteen of the 19 patients showed pain reduction (6 excellent, 3 good, and 5 fair) using the MCS with our results indicating area 4 within the central sulcus to be the optimal stimulation point for pain relief. We speculate that conventional method may sometimes fail to stimulate area 4 and that focal stimulation of the primary motor cortex within the central sulcus may improve the efficacy of this treatment. Our pharmacological tests show that patients with ketamine sensitivity seem to be good candidates for MCS. Test stimulation with a subdural multi-grid electrode and Resumes in the cetral sulcus were helpful in locating the best stimulation point for pain relief.

Ferguson Smith type multiple keratoacanthomas and a keratoacanthoma centrifugum marginatum in a woman from Japan

We report a case of multiple keratoacanthomas on the sun-exposed skin of a 37-year-old woman from Japan. She had experienced 4 similar episodes of evolution and involution of multiple keratoacanthomas during a period of 10 years since she was 27 years old. She was given the diagnosis of Ferguson Smith type keratoacanthoma. This is the seventh Japanese case of Ferguson Smith type keratoacanthoma described in detail in the literature. In addition, the patient was found to have an annular, coral reef-like eruption on the front of her neck, which was diagnosed as a keratoacanthoma centrifugum marginatum. A combination of different variants of keratoacanthoma in 1 patient is uncommon, and only 2 patients with the same combination of lesions, as that seen in our patient, have been reported. Our patient was treated by a relatively low dose (0.5 mg/kg body weight) of etretinate. Both variants of keratoacanthoma showed good response to the treatment. Effectiveness of etretinate for treating keratoacanthoma centrifugum marginatum has only been reported in a few cases. Our patient had no relapse during a period of 15 months after cessation of etretinate treatment.

Activation of caspase-12 by endoplasmic reticulum stress induced by transient middle cerebral artery occlusion in mice

We sought to clarify the involvement of caspase-12, a representative molecule related to endoplasmic reticulum (ER) stress-induced cell-death signaling pathways, in neuronal death resulting from ischemia/reperfusion in mice. Transient focal cerebral ischemia (1 h) was produced by intraluminal occlusion of the middle cerebral artery (MCA). We assessed the expression patterns of caspase-12, Bip/GRP78, an ER-resident molecular chaperone whose expression serves as a good marker of ER stress, and caspase-7 by Western blotting and/or immunohistochemistry. Double-fluorescent staining of caspase-12 immunohistochemistry and the terminal deoxynucleotidyl transferase-mediated DNA nick-end labeling (TUNEL) method was performed to clarify the involvement of caspase-12 in cell death. We confirmed that ER stress was induced during reperfusion in our model, as witnessed by up-regulated Bip/GRP78 expression in the MCA territory. Western blot analysis revealed that caspase-12 activation occurred at 5-23 h of reperfusion, and immunoreactivity for caspase-12 was enhanced mainly in striatal neurons on the ischemic side at the same time points. We found the co-localization of caspase-12 immunoreactivity and DNA fragmentation detectable by the TUNEL method. We did not detect the presence of caspase-7 in the ER fraction at the period of caspase-12 cleavage. Our results imply that cerebral ischemia/reperfusion induces ER stress and that caspase-12 activation concurred with ER stress. Caspase-12 seems to be involved in neuronal death induced by ischemia/reperfusion. Caspase-7 is not likely to contribute to the cleavage of caspase-12 in our experimental model.

MR imaging of uncommon recurrence of fibrolipomatous hamartoma of the ulnar nerve

We present the MR and histopathologic findings of fibrolipomatous hamartoma (FLH) of the ulnar nerve in a 54-year-old woman, a lipomatous process that rarely affects the ulnar nerve. The case illustrated is further unusual as a local soft tissue recurrent mass developed over a remarkably long course of the disease.

Management of haemophilia B inhibitor patients with anaphylactic reactions to FIX concentrates

Allergic reactions to concentrates containing factor IX (FIX) are serious complications in the treatment of haemophilia B patients with inhibitor. We have established a therapeutic protocol for such cases using an initial skin test followed by step-wise infusions of FIX concentrates under hydrocortisone cover. We have successfully treated three patients whose treatment with FIX had been suspended.

Regulation of FLRG expression in rat primary astroglial cells and injured brain tissue by transforming growth factor-beta 1 (TGF-beta 1)

Follistatin-related gene (FLRG) is a member of the follistatin family of proteins and interacts with transforming growth factor (TGF) superfamily proteins like follistatin. To understand the expression level of FLRG in brain tissue, we examined whether primary neurons and glial cells from rat embryos express FLRG mRNA and produce its protein product. FLRG and follistain mRNAs were mainly expressed in astroglial cells, while activin A mRNA was abundant in primary neurons. TGF-beta1 highly enhanced expression levels of FLRG mRNA in astroglial cells, compared with those of follistatin and activin A mRNAs. Particularly, TGF-beta1 facilitated the secretion of FLRG protein from primary astroglial cells in a dose-dependent manner. Moreover, changes in expression levels of FLRG mRNA and protein in brain tissue were also analyzed after a penetrating injury, using quantitative polymerase chain reactin (PCR) and immunohistochemical methods. Expression levels of FLRG mRNA were significantly increased in damaged regions after penetrating injury together with those of activin A and TGF-beta1 mRNAs. Immunohistochemical observations showed that positive signals of FLRG protein were colocalized in glial fibrillary acidic protein-positive reactive astroglial cells located in damaged regions after a penetrating injury. The expression of follistatin mRNA rather decreased in damage regions after the brain injury. These results suggest that FLRG is synthesized in and secreted from astroglial cells. In particular, FLRG, but not follistatin, may play a role in the regulation of activin A in brain wound healing in response to TGF-beta1.

Toxicological study of a glucose-added acetic acid maintenance infusion solution (VEEN 3G Inj.) local irritation test

The local irritating effect of Veen 3G Inj. (glucose-added acetic acid maintenance infusion solution) was examined in male rabbits. We studied the local irritating effect of the infusion solution compared with that of Ringer's solution, 5% sulfobromophthalein sodium injection, distilled water for injection or glucose-added Ringer's solution. In the vascular irritation test, macroscopical and histopathological changes induced by the infusion solution were not observed in the vessels. Moreover, in the hemolytic test, hemolysis of rabbit erythrocyte was not observed in the mixture with the infusion solution. In the present study, no change suggesting irritation by the infusion solution was observed in the in vivo vascular irritation test using the auricular vein of rabbits or in the in vitro hemolytic test using rabbit erythrocyte. In conclusion, in clinical use the infusion solution produces extremely slight adverse effects, such as vessel pain and phlebitis on the injection site.

Exercise prescription based upon cardiac vagal activity for middle-aged obese women

OBJECTIVE

The purposes of this study were to examine a new method to determine exercise intensity for obese people based on the cardiac vagal activity and to determine the effect of this approach on myocardial stress.

SUBJECTS

Forty-three middle aged obese female volunteers (age 43.7+/-6.5 y; height 1.56+/-0.05 m; body mass 66.5+/-9.3 kg; body mass index 27.3+/-2.8 kg m(2); percentage body fat 40.7+/-5.9%).

MEASUREMENT

In the first experiment, 43 subjects performed a ramp exercise test on a bicycle ergometer with measurement of ECG and gas exchange parameters. In the second experiment, 11 subjects performed 45 min of constant walking exercise on a treadmill at a level corresponding to exercise intensity determined by vagal activity obtained from a ramp bicycle test. Blood pressure, endothelin 1 (ET-1), catecholamine, atrial natriuretic peptide (ANP), and brain natriuretic peptide (BNP) were measured before and after exercise.

RESULTS

The heart rate variability power decreased with increasing work rate, and changed little after reaching individual-specific work rate. We presumed that vagal activity disappeared at this point and that the heart rate at this exercise intensity was determined as the vagal activity threshold (T(VA)). The results showed a significant positive correlation (r=0.742, P<0.0001) between T(VA) and ventilatory threshold (VT) heart rates, although the mean heart rate of T(VA) (114.3+/-8.5 beats/min) was significantly lower (P<0.001) than that at VT (119.0+/-11.7), suggesting the cardiac vagal withdrawal occurred prior to the onset of lactate acidosis (lactic acid accumulation). Furthermore, exercise intervention experiment at T(VA) indicated that ET-1, catecholamine and BNP levels were not significantly different before and after exercise. However, ANP levels increased significantly after exercise (pre-exercise 18.6+/-5.38 vs post-exercise 44.0+/-24.87 pg/ml, P<0.001), which in turn brought about a significant post-exercise reduction in the blood pressure (SBP 117.6+/-13.7 vs 110.5+/-7.4 mmHg, P<0.05; DBP 78.6+/-6.7 vs 73.5+/-6.6 mmHg, P<0.01).

CONCLUSION

Our data suggest that it is possible to determine the exercise intensity (T(VA)) on the basis of cardiac vagal response. These results also suggest that exercise at T(VA) level is a safe exercise intensity in the light of cardiac stress, and that T(VA) may be recommended for obese people who might possess lower cardiac sympatho-vagal activity.

Toxicological study of a new maintenance fluid, Veen 3G, in rats

A study of the different volume and infusion rates of a new maintenance fluid, Veen 3G, on the general conditions of rats was investigated during the 14 days after infusion. In Experiment I, 100 ml/kg and 200 ml/kg of Veen 3G were infused at a rate of 300 ml/kg/h in male and female rats. Results were compared with those for Gurunon Ringer solution (GRS) in male and female rats. We observed only transient polyuria in animals administered by each dose of Veen 3G and GRS for 0-15 min after infusion. Necropsy was not observed in any of the animals tested 14 days after infusion. In Experiment II, 200 ml/kg of Veen 3G was infused at rates of 200, 400, 800 and 1600 ml/kg/h in male rats. At 800 and 1600 ml/kg/h, irregular respiration and decrease in movement were observed concomitantly with polyuria. Three out of 4 rats died immediately after the infusion of Veen 3G at a rate of 1600 ml/kg/h, and one rat was still alive 14 days after the infusion. In this experiment, 200 ml/kg Veen 3G was safe when we infused at a rate of less than 400 ml/kg/h in male rats. Since this rate is about 27-80 times higher than that used clinically in maintenance treatment, Veen 3G is suggested to be safe, with the exception of polyuria, in clinical situations at the standard infusion rate (5-15 ml/kg/h).

A male patient who developed late-onset primary biliary cirrhosis presenting with antinuclear envelope antibodies

Abstract An 81-year-old man who had previously shown high levels of alkaline phosphatase (ALP), γ-glutamyltransferase (GTP), and total bilirubin presented with acute liver damage. He was positive for serum anti-gp210 and anti-p62 antibodies, but negative for serum antimitochondrial antibody. A liver biopsy revealed massive interstitial fibrosis and pseudolobulus, which were compatible with a diagnosis of primary biliary cirrhosis (PBC) at Scheuer's stage 4. He was given ursodeoxycolic acid at 600 mg/day. However, his condition deteriorated, and he eventually died of hepatic insufficiency in a state of malnutrition. We hypothesize that the presence of anti-gp210 and anti-p62 complex protein antibodies, rather than that of antimitochondrial antibodies, was correlated with the progression of PBC in this particular case.

Nephropathy of cyanotic congenital heart disease: clinical characteristics and effectiveness of an angiotensin-converting enzyme inhibitor

AIMS

Nephropathy has long been recognized as a potential complication of cyanotic congenital heart disease (CCHD). There have been few large-scale studies or clinical reports on renal impairment in patients with CCHD; similarly, very few studies have examined the drug treatment of nephropathy in CCHD. We examined the clinical characteristics and effectiveness of enalapril, an angiotensin-converting enzyme inhibitor (ACE-I), in patients with CCHD complicated with significant proteinuria.

MATERIALS AND METHODS

The clinical records of 37 patients with CCHD were evaluated; all were older than 10 years of age (median 19, range from 10 to 27) and had regular check-ups, including urinalysis. The treatment criteria for enalapril administration included significant proteinuria (urinary excretion > 1.0 g/24 h), stable cardiac condition and blood pressure within the normal range.

RESULTS

Eleven patients (29.7%) had persistent proteinuria, 6 patients met the enalapril treatment criteria and 5 patients were treated for more than 12 months. Enalapril apparently reduced the urinary protein excretion in 4 of the 5 patients (80%). No consistent improvement of renal function, as evidenced in the glomerular filtration rate (GFR), renal plasma flow (RPF) or filtration fraction (FF) was found in these patients, but neither were any significant adverse effects noted.

CONCLUSION

The incidence of nephropathy among patients with CCHD was about 30%, which was consistent with previous studies. It is worth considering the use of ACE-I when nephropathy accompanies CCHD.

Glucagon is paradoxically secreted at high concentrations of glucose in rat pancreas perfused with diazoxide

To study the role of B-cells in the regulation of glucagon secretion by glucose, the rat pancreas was perfused with 0.4 mmol/l diazoxide. Perfusate glucose was 5 mmol/l of a basal concentration, and then was decreased to 1 mmol/l, or was increased to 15 mmol/l. Insulin secretion was suppressed by diazoxide below the detectable level at each glucose concentration. Glucagon secretion was increased two-fold during the glucopenic perfusion without diazoxide, but was not changed at a low glucose concentration in the presence of diazoxide. During the glucose-excessive perfusion for 15 min, glucagon secretion was lowered from 0.69 +/- 0.17 pmol at 5 mmol/l glucose to 0.36 +/- 0.10 pmol at 15 mmol/l glucose (p < 0.05) without diazoxide, whereas that was inversely increased from 0.55 +/- 0.14 at 5 mmol/l glucose to 0.85 +/- 0.13 pmol at 15 mmol/l glucose (p < 0.05) in the presence of diazoxide. These results suggest that appropriate insulin secretion is necessary for the normal responses of glucagon secretion to hypoglycemia and hyperglycemia in the non-diabetic rat pancreas.

[Endobronchial brachytherapy for intra-luminal recurrence after lung cancer resection]

A 63-year-old man who had squamous cell carcinoma in left lung was received left lower lobectomy with lymph node dissection (pT3N0M0). Twenty months after surgery, the patient showed bloody sputum and bronchofiberscopy revealed intra-luminal recurrence on trachea. Endobronchial brachytherapy in combination with external beam radiotherapy was selected and complete remission was achieved. After the brachytherapy, bronchitis was observed and was healed 23 months after the therapy.

Decay scheme of 126La isomers

The beta+/EC decay of 126La produced by the 94Mo(36Ar, 3pn) reaction has been studied using the on-line isotope separator connected to an AVF cyclotron. Gamma-ray singles, gamma-gamma angular correlation and internal conversion electron measurements were carried out. From analysis of these data, 33 new levels in 126Ba were found and the decay scheme containing 137 gamma-rays and 50 excited states was constructed. The probable spin and parity of the two beta-decaying states in 126La were found to be 4+/-, 5+/- for the high-spin isomer with a half-life of 54(2) s and 0-, 1+/-, 2- for the low-spin isomer with a half-life shorter than 50 s.

Assessment of coronary flow velocity reserve using fast velocity-encoded cine MRI for noninvasive detection of restenosis after coronary stent implantation

PURPOSE

Serial change of the coronary flow velocity reserve was evaluated with fast velocity-encoded cine magnetic resonance imaging (MRI) for noninvasive detection of restenosis after coronary stent implantation.

METHOD

In total, 60 MRI flow studies were performed in 10 patients with coronary artery disease who undersvent elective successful stent implantation to the lesion in the proximal left anterior descending artery. Flow velocities in the segment that was distal to the stent were measured before and after intravenous injection of dipyridamole. MRI measurements of coronary flow velocity reserve were repeated every 4 weeks for 6 months, and follow-up angiography was performed 6 months after the procedure.

RESULTS

In patients without restenosis (n = 7, % diameter stenosis: 27.8%+/-7.1) at follow-up angiography, the coronary flow velocity reserve remained normal during the 6-month follow-up time. The flow velocity reserve was 2.31+/-0.30 at 1 month and 2.52+/-0.25 at 6 months after stent implantation (p = NS). In contrast, the coronary flow velocity reserve showed a significant decrease after 4 months in patients with restenosis (n = 3, % diameter stenosis: 66.3%+/-8.1) at follow-up angiography. The flow velocity reserve was 2.26+/-0.49 at 1 month and 1.52+/-0.09 at 6 months after stent implantation (p < 0.05).

CONCLUSION

Fast velocity-encoded cine MRI is a technique that shows promise in providing non-invasive detection of restenosis of coronary stent implantation.

Low-dosage intravenous immunoglobulin in the management of a patient with acquired von Willebrand syndrome associated with monoclonal gammopathy of undetermined significance

We report herein the case of a 69-year-old Japanese man with acquired von Willebrand syndrome associated with monoclonal gammopathy of undetermined significance who developed IgG1-kappa antibodies against von Willebrand factor (VWF). The patient was urged to undergo tooth extractions because of alveolar pyorrhea, and a low-dosage intravenous immunoglobulin (IV-Ig) therapy (0.3 g of IgG/kg/day for 3 days) was chosen for him. On the 4th day after the infusion, VWF antigen and VWF ristocetin cofactor increased to 40 and 78% of the control, respectively, and dental extractions were performed successfully. On the 7th day, these values reached a maximum, i.e. 95 and 160% of the control, respectively. Then, they quickly decreased to 35 and 75% on the 10th day, and 6 months later, they became 16 and <3% of the control, respectively. Upon analysis of plasma VWF multimers (VWFMs) in this patient, those with large to medium molecular masses more selectively disappeared before the IV-Ig infusion than did those with small molecular masses. On the 4th day, the pattern of VWFMs was completely normalized and appeared to persist until the 10th day. Six months later, a small amount of large to medium-sized VWFMs was still present, but at 7-8 months, the pattern of VWFMs became almost the same as that before infusion. Throughout the patient's clinical course, the activity of plasma VWF-cleaving protease, which specifically cleaves the Tyr842-Met843 bond of the subunit and reduces its multimeric sizes, was quite normal (95-119%). These results provided consistent evidence that the selective absence of VWFMs with large to medium molecular masses in this patient is caused by the heightened clearance of a complex of IgG inhibitor and VWFMs from the circulation, presumably through IgG binding to the Fc receptor of macrophages. Furthermore, these results also indicated that a low-dosage IV-Ig therapy is effective enough for hemostatic management for programmed surgery.

Synthesis of beta-galactose-conjugated chlorins derived by enyne metathesis as galectin-specific photosensitizers for photodynamic therapy

A first report on the synthesis and biological evaluation of the beta-galactose-conjugated purpurinimides (a class of chlorins containing a six-membered fused imide ring system) as Gal-1 (galectin-1) recognized photosensitizers, prepared from purpurin-N-propargylimide via enyne metathesis, is discussed. On the basis of examination of the available crystal structure of the galectin-1 N-acetyllactose amine complex, it was considered that the chlorin-based photosensitizers could be introduced into a carbohydrate skeleton to expand the repertoire of the galectin-1-specific ligands. Preliminary molecular modeling analysis utilizing the modeled photosensitizers and the available crystal structures of galectin-carbohydrate complexes indicated that addition of the photosensitizer to the carbohydrate moiety at an appropriate position does not interfere with the galectin-carbohydrate recognition. Under similar drug and light doses, compared to the free purpurinimide analogue, the purpurinimides conjugated either with galactose or with lactose (Gal(beta1-4)-Glc) produced a considerable increase in photosensitizing efficacy in vitro. This indicates the possibility for development of a new class of specific photosensitizers for photodynamic therapy (PDT) based on recognition of a cellular receptor.

Lactosylceramide is essential for the osteoclastogenesis mediated by macrophage-colony-stimulating factor and receptor activator of nuclear factor-kappa B ligand

Glycosphingolipids and their metabolites play important roles in a variety of biological processes. Several signal molecules are localized in a glycolipid-enriched microdomain on the cell surface, and their signals are regulated by the glycolipid composition. However, the function of glycolipids in osteoclastogenesis has not been clearly understood. We found that D-threo-1-phenyl-2-decanoylamino-3-morpholino-1-propanol (D-PDMP), a glucosylceramide synthase inhibitor, completely inhibits the osteoclast formation induced by macrophage-colony-stimulating factor and receptor activator of nuclear factor-kappa B ligand (RANKL) in a dose-dependent manner. Expression of RANK, the receptor of RANKL, induced by macrophage colony-stimulating factor, was reduced markedly in D-PDMP-treated cells. d-PDMP also inhibited the phosphorylation of the inhibitor of nuclear factor-kappa B and extracellular signal-regulated kinase 1/2 induced by RANKL. In several experiments with the addition of glycolipids to D-PDMP-treated purified bone marrow cells, lactosylceramide (LacCer) strongly affected the differentiation into tartrate-resistant acid phosphatase mononucleated cells, but not positive multinucleated cells. GM3 and GM1 also recovered, but less effectively compared with LacCer. Moreover, exogenous LacCer recovered the reduced expression of RANK and the phosphorylation of inhibitor of NF-kappa B and extracellular signal-regulated kinase 1/2 after stimulation by RANKL at the same level of cells without D-PDMP treatment. Our data suggest that glycosphingolipids, especially LacCer, are necessary for the initiation step of RANKL-induced osteoclastogenesis.

The involvement of vascular endothelial growth factor and flt-1 in the process of neointimal proliferation in pig coronary arteries following stent implantation

To clarify the role of vascular endothelial growth factor (VEGF) in the process of restenosis, a Palmaz-Schatz stent was implanted in the left anterior descending coronary artery of male pigs at 2 weeks after balloon injury (balloon/artery ratio 1.2:1). The animals were euthanized at 1, 2, and 4 weeks after stenting, and western blot and immunohistochemical analysis were performed using VEGF, fms-like tyrosine kinase (flt)-1, and platelet-derived growth factor (PDGF) antibodies. The expressions of VEGF and flt-1 protein in the neointima were observed as early as 1 week after stenting and remained for up to 4 weeks, while re-endothelialization was complete at 2 weeks. These protein expressions were demonstrated in proliferated smooth muscle cells throughout the entire period after stenting and, in addition, they were observed in the macrophages and endothelial cells of microvessels around stent struts at 4 weeks. The expression pattern of VEGF corresponded with that of PDGF, a growth factor well-known to induce neointimal proliferation. The cell proliferative activity, measured by the proliferating cell nuclear antigen index, around the struts remained high until 4 weeks after stenting, while that in the other areas declined at 4 weeks. These results suggest that VEGF is involved in the process of restenosis not only through its angiogenic properties and induction of monocyte chemotaxis, but also by a synergistic effect with PDGF.

Combined hepatocellular carcinoma and cholangiocarcinoma growing into the common bile duct

We report a patient with combined hepatocellular carcinoma and cholangiocarcinoma (HCC-CC) growing into the common bile duct (CBD) and showing obstructive jaundice within 2 years of the onset of the disease. The patient was a 59-year-old Japanese man in whom, at the age of 57 years. a hepatic tumor was discovered by diagnostic imaging during follow-up of hepatitis B surface antigen (HBsAg)-positive liver cirrhosis. The tumor was diagnosed as HCC. Epirubicin was injected twice, intraarterially. The patient then received oral etoposide therapy for the next 14 months. The treatment was initially effective, but approximately 2 years after the hepatic tumor was discovered, local recurrence of the tumor and a tumor thrombus in the CBD were discovered. Although he was treated with percutaneous transhepatic biliary drainage (PTBD), to reduce obstructive jaundice, the jaundice was irreversible and he died of severe hepatic failure. The autopsy findings confirmed that the hepatic tumor was HCC-CC, in which the HCC and CC components expressed alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9), respectively, which accurately reflected the disease process. The underlying mechanism of the growth of HCC-CC into the CBD may differ from the underlying mechanism of the development of icteric-type HCC.

Dissociation of Bax from a Bcl-2/Bax heterodimer triggered by phosphorylation of serine 70 of Bcl-2

Serine 70 in the loop region of Bcl-2 is specifically phosphorylated by paclitaxel-treatment in tumor cells and BHK cells expressing Bcl-2. The phosphorylation of serine 70 of Bcl-2 (pS70-Bcl-2) peaks 24 to 48 h after paclitaxel treatment and accelerates apoptosis. Phosphorylation is effectively inhibited in the presence of actinomycin D or cycloheximide, which restore cell viability to the same level as control cells not expressing Bcl-2. These results indicate that paclitaxel-induced kinase(s) and/or its activator(s) are synthesized de novo and play an important role in paclitaxel-induced apoptosis by phosphorylating Bcl-2. In binding assays using the phosphorylation-specific antibody against pS70-Bcl-2, the induction of serine 70 phosphorylation 70 results in a loss of the binding ability of Bcl-2 to Bax, a pro-apoptotic partner, and induces subsequent cell death. When the pS70-Bcl-2 antibody was added to human breast cancer tissue, serine 70 phosphorylation was also detected, even prior to treatment with anticancer agents. Further study of breast cancers revealed 83% of tumors with high pS70-Bcl-2 expression responded to paclitaxel or docetaxel treatment, whereas 57% of those with low expression not respond. These findings suggest that pS70-Bcl-2 might be a predictive factor for prognosis and sensitivity to paclitaxel treatment for breast cancer.

Pupillary abnormality on admission and brain bulging during surgery as unfavourable predictors in patients treated with hypothermia: a retrospective review of 81 patients with severe head injury

BACKGROUND

To determine factors predicting outcome of patients with severe head injury, the authors retrospectively analyzed 81 patients, 3 to 70 years of age, who were treated by hypothermia.

METHOD

The initial Glasgow Coma Scale scores of the 81 patients ranged from 3 to 8. Outcome in each case was determined at six months after injury and was retrospectively analyzed with respect to patient characteristics, initial clinical status, laboratory data, computed tomographic findings, data from monitoring, intra-operative findings, and treatment methods. The significance of clinical and neuroradiological factors for predicting unfavorable outcome was analyzed by univariate logistic regression. Stepwise multiple logistic regression analysis was then used to identify independent predictors of outcome.

FINDINGS

Favorable outcome was observed in 27 of 81 patients treated by hypothermia. Independent factors predicting unfavorable outcome included pupillary abnormality on admission and brain bulging during surgery.

INTERPRETATION

Therapeutic effectiveness of hypothermia was thus limited in patients who presented with these grave symptoms.

A new neurological entity manifesting as involuntary movements and dysarthria with possible abnormal copper metabolism

A few patients with an affected CNS involving abnormalities in copper metabolism have been described that do not fit any known nosological entities such as Wilson's disease or Menkes' disease. Three sporadic patients (two men and one woman) were examined with involuntary movements and dysarthria associated with abnormal concentrations of serum copper, serum ceruloplasmin, and urinary copper excretion. The onset of neurological symptoms occurred at the age of 15 to 17 years. The common clinical symptoms were involuntary movements and dysarthria. The involuntary movements included dystonia in the neck, myoclonus in the shoulder, athetosis in the neck, and rapid orobuccal movements. The dysarthria consisted of unclear, slow, and stuttering speech. Two of the three patients did not have dementia. A cousin of the female patient had been diagnosed as having Wilson's disease and had died of liver cirrhosis. Laboratory findings showed a mild reduction in serum copper and ceruloplasmin concentrations, whereas urinary copper excretion was significantly reduced in all three patients. Two of the three patients showed a high signal intensity in the basal ganglia on T2 weighted brain MRI. In conclusion, the unique findings of involuntary movements, dysarthria, and abnormal serum copper and urinary copper concentrations suggest that the three patients may constitute a new clinical entity that is distinct from either Wilson's or Menkes disease.