Neuromuscular effects of sevoflurane in patients with myasthenia gravis

The current study evaluated the neuromuscular responses following administration of sevoflurane in 14 patients with myasthenia gravis (MG) (I-IIb in Osserman's classification) scheduled for thymectomy and in 11 control patients (ASA I-II) who underwent elective surgery. The electromyographic (EMG) response of the abductor digiti minimi was measured following train-of-four (TOF) stimulation of the ulnar nerve every 20 s. After induction of anesthesia with a combination of 3-4 mg·kg(-1) thiopental and 1-2 μg·kg(-1) fentanyl with 66% N2O and oxygen, an inspired concentration of 4% sevoflurane was administered via a face mask for 7 min. Anesthesia was maintained during surgery with 66% N2O in oxygen and with 1 minimum alveolar concentration (MAC) of end-tidal concentration of sevoflurane. The T1 (the amplitude of the first response) values decreased more profoundly in the MG patients than in the control patients at the end of surgery (P<0.05). Following administration of 4% sevoflurane for 7 min, the TOFR (the ratio of the fourth TOF to the first response) values revealed depressions greater than 10% of preinhalation values in 11 of 14 MG patients with a marked individual variation. This attenuated response was followed by a further depression of the TOFR values with increasing time of 1 MAC sevoflurane anesthesia. On the other hand, no notable changes were observed in patients with normal neuromuscular functions. The most significant factor that correlated with the depression of the TOFR values induced by 1 MAC sevoflurane was the anti-AchR antibody titers (P=0.029). Our results indicate that MG patients have an increased neuromuscular sensitivity to sevoflurane.

Germ cell transplantation as a potential biotechnological approach to fish reproduction

Although the use of germ cell transplantation has been relatively well established in mammals, the technique has only been adapted for use in fish after entering the 2000s. During the last decade, several different approaches have been developed for germ cell transplantation in fish using recipients of various ages and life stages, such as blastula-stage embryos, newly hatched larvae and sexually mature specimens. As germ cells can develop into live organisms through maturation and fertilization processes, germ cell transplantation in fish has opened up new avenues of research in reproductive biotechnology and aquaculture. For instance, the use of xenotransplantation in fish has lead to advances in the conservation of endangered species and the production of commercially valuable fish using surrogated recipients. Further, this could also facilitate the engineering of transgenic fish. However, as is the case with mammals, knowledge regarding the basic biology and physiology of germline stem cells in fish remains incomplete, imposing a considerable limitation on the application of germ cell transplantation in fish. Furthering our understanding of germline stem cells would contribute significantly to advances regarding germ cell transplantation in fish.

Comparative study on the pathogenesis of the generated 9a5b Newcastle disease virus mutant isolate between chickens and waterfowl

Lentogenic Newcastle disease viruses (NDVs), circulating among waterfowl, have the potential to become highly pathogenic by replication in chickens. The pathological studies that compare NDV infections in chickens and waterfowl are rare. The virulent 9a5b mutant NDV isolate was generated by passaging the lentogenic Goose/Alaska/415/91 NDV isolate in chickens. The pathogenesis of the virulent 9a5b mutant isolate is unknown in both chickens and waterfowl. In this study, the virulent 9a5b mutant NDV isolate was inoculated intranasally in 32-day-old specific pathogen-free white Leghorn chickens and Japanese commercial ducks. Unlike ducks, which remained clinically normal throughout the study, chickens had depression, gasping, oral discharges, and greenish-white soft feces. Gross and histologic lesion patterns as well as viral replication supported the differing clinical outcome. Ducks had slight inflammation mainly in respiratory and digestive tracts, whereas slight nonpurulent encephalitis, necrotizing pancreatitis, tubulointerstitial nephritis, and mild inflammation in respiratory and digestive tracts were detected in chickens. In agreement, interferon-beta (IFN-β)-immunopositive signals were more intense in lung tissue of ducks than that of chickens, and NDV replications were detected intensively in chicken tissues. These results suggest that the 9a5b mutant NDV isolate is more virulent in chickens, and slight histological lesions were induced in ducks even with virulent NDVs.

Optical pyrometer system for collisionless shock experiments in high-power laser-produced plasmas

A temporally and spatially resolved optical pyrometer system has been fielded on Gekko XII experiments. The system is based on the self-emission measurements with a gated optical imager (GOI) and a streaked optical pyrometer (SOP). Both detectors measure the intensity of the self-emission from laser-produced plasmas at the wavelength of 450 nm with a bandpass filter with a width of ~10 nm in FWHM. The measurements were calibrated with different methods, and both results agreed with each other within 30% as previously reported [T. Morita et al., Astrophys. Space Sci. 336, 283 (2011)]. As a tool for measuring the properties of low-density plasmas, the system is applicable for the measurements of the electron temperature and density in collisionless shock experiments [Y. Kuramitsu et al., Phys. Rev. Lett. 106, 175002 (2011)].

Production of donor-derived offspring by allogeneic transplantation of spermatogonia in the yellowtail (Seriola quinqueradiata)

Although the yellowtail (Seriola quinqueradiata) is the fish most commonly farmed in Japan, breeding of this species has not yet started. This is primarily due to the lack of sufficiently sophisticated methods for manipulating gametogenesis, which makes it difficult to collect gametes from specific dams and sires. If it were possible to produce large numbers of surrogate fish by transplanting germ cells isolated from donor individuals harboring desirable genetic traits, then the probability of acquiring gametes carrying the donor-derived haplotype would increase, and breeding programs involving this species might increase as a result. As a first step, we established a method for the allogeneic transplantation of yellowtail spermatogonia and the production of donor-derived offspring. Donor cells were collected from immature (10-month-old) yellowtail males with testes containing abundant type A spermatogonia, labeled with PKH26 fluorescent dye, and transferred into the peritoneal cavities of 8-day-old larvae. Fluorescence observation at 28 days post-transplantation revealed that PKH26-labeled cells were incorporated into recipients' gonads. To assess whether donor-derived spermatogonia could differentiate into functional gametes in the allogeneic recipient gonads, gametes collected from nine male and four female adult recipients were fertilized with wild-type eggs and milt. Analysis of microsatellite DNA markers confirmed that some of the first filial (F(1)) offspring were derived from donor fish, with the average contribution of donor-derived F(1) offspring being 66% and the maximum reaching 99%. These findings confirmed that our method was effective for transplanting yellowtail spermatogonia into allogeneic larvae to produce donor-derived offspring.

Kelvin-Helmholtz turbulence associated with collisionless shocks in laser produced plasmas

We report the experimental results of a turbulent electric field driven by Kelvin-Helmholtz instability associated with laser produced collisionless shock waves. By irradiating an aluminum double plane target with a high-power laser, counterstreaming plasma flows are generated. As the consequence of the two plasma interactions, two shock waves and the contact surface are excited. The shock electric field and transverse modulation of the contact surface are observed by proton radiography. Performing hydrodynamic simulations, we reproduce the time evolutions of the reverse shocks and the transverse modulation driven by Kelvin-Helmholtz instability.

STABILIZATION EFFECTS OF GRAF LIGAMENTOPLASTY

Graf ligamentoplasty with or without decompression was performed consecutively in 22 patients of lumbar degenerative diseases with segmental instability. The clinical course of the patients was evaluated using the criteria of the Japanese Orthopaedic Association (JOA) for assessing treatment of low back pain (29 points in total), and radiological alteration in angular and translational displacements were measured in flexion, extension, or neutral position. The change of an intervertebral vacuum phenomenon (Knutsson's sign), as a sign of segmental instability, was observed before and after the surgery.

A preoperative JOA score of 13.7 points was significantly improved to 25.0 points with an improvement rate of 75.7% on average by Graf ligamentoplasty. Radiological measurements revealed that the operation reduced the range of motion of the involved segment in both angular and translational modes with the segment realigned in extension. The short-term results of Graf ligamentoplasty was acceptable for lumbar degenerative diseases. The patients in whom Knutsson's sign was reduced or disappeared after Graf ligamentoplasty had a better outcome than those with the sign unchanged or increased in size. This suggests that Knutsson's sign can be a predictive indicator of the outcome of the surgery.

Primary (de novo) dedifferentiated liposarcoma in the extremities: a multi-institution Tohoku Musculoskeletal Tumor Society study of 18 cases in northern Japan

OBJECTIVE

Dedifferentiated liposarcomas usually occur in the retroperitoneal space and relatively rarely in the extremities.

METHODS

We identified 18 patients with primary dedifferentiated liposarcoma in the extremities from the files of Tohoku Musculoskeletal Tumor Society and analyzed demographics, histologic findings, treatments and prognostic factors. The average follow-up period was 58 months.

RESULTS

The subjects were 12 men and 6 women with a mean age of 65 years. All tumors were in the thigh. Nine patients noticed a rapid enlargement of the long-standing tumor. Histologic subtypes of the dedifferentiated area were undifferentiated pleomorphic sarcoma (n = 12), osteosarcoma (n = 2), rhabdomyosarcoma (n = 2), leiomyosarcoma (n = 1) and malignant peripheral nerve sheath tumor (n = 1). In the patient with rhabdomyosarcoma-like dedifferentiated area, extensive necrosis was observed after the preoperative chemotherapy. One patient who underwent marginal excision developed a local recurrence, but inadequate surgical margin was not associated with a risk of local recurrence. Three patients had lung metastasis at initial presentation, and four other patients developed lung metastases during the follow-up period. The overall survival rate was 61.1% at 5 years. On univariate analyses, large size of the dedifferentiated area (>8 cm), high MIB-1-labeling index (>30%) for the dedifferentiated area and lung metastasis at initial presentation were significantly associated with poor prognosis.

CONCLUSIONS

Primary dedifferentiated liposarcoma in the extremities predominantly occurred in the thigh and a rapid enlargement of long-standing tumors was a characteristic symptom. Although the local behavior of these tumors was less aggressive than that of retroperitoneal dedifferentiated liposarcomas, they had a relatively high metastatic potential.

Time evolution of collisionless shock in counterstreaming laser-produced plasmas

We investigated the time evolution of a strong collisionless shock in counterstreaming plasmas produced using a high-power laser pulse. The counterstreaming plasmas were generated by irradiating a CH double-plane target with the laser. In self-emission streaked optical pyrometry data, steepening of the self-emission profile as the two-plasma interaction evolved indicated shock formation. The shock thickness was less than the mean free path of the counterstreaming ions. Two-dimensional snapshots of the self-emission and shadowgrams also showed very thin shock structures. The Mach numbers estimated from the flow velocity and the brightness temperatures are very high.

Chemically-Enhanced GaAs Maskless Etching Using a Novel Focused Ion Beam Etching System with a Chlorine Molecular and Radical Beam

Chlorine-enhanced GaAs maskless etching using a novel focused-ion-beametching (FIBE) system has been examined for establishing high-rate and smooth FIBE. The system is composed of an air-locked ultrahigh-vacuum chamber, a 30 KeV Ga+ FIB column and two kinds of chlorine-irradiation nozzles. A fine nozzle enabled us to irradiate a high-density Cl2 flux on a desired, small area of the sample while retaining a sufficiently low surrounding-gas pressure for stable Ga+ FIB emission. Highly chemically-enhanced sputtering yields (up to 50 GaAs molecules per incident ion) were obtained. At the maximum yield, line-scanned deep-groove (6.5 um) etching with a smooth surface, capable of fabricating a laser-cavity optical mirror, was demonstrated. The chemical-enhancement effect showed high FIB-scanning-time dependence. This effect was also observed by irradiating with a plasma-dissociated Cl radicals using a novel radical beam gun. An analytical model, based on the Ga+-ion bombardment on the chlorine-adsorbed substrate surface, suggested that the maximum chemical enhancement is obtained when the Ga+-FIB scanning time is adjusted to the chlorine-coverage time, given by the Cl2-molecule or Cl-radical flux density.

Enhancement of TNF-α expression and inhibition of glucose uptake by nicotine in the presence of a free fatty acid in C2C12 skeletal myocytes

Smoking is a risk factor for insulin resistance and metabolic syndrome. However, mechanisms responsible for smoking-induced insulin resistance are unclear. We examined the combined effect of nicotine, a toxic substance in tobacco smoke, and palmitate in the serum physiological concentration range on tumor necrosis factor-α (TNF-α) expression and impairment of glucose uptake in C2C12 myotubes, since smokers do not have increased serum free fatty acid (FFA) concentrations with insulin resistance compared to nonsmokers. C2C12 myotubes were incubated for 24 h with nicotine (1 μmol/l) in the presence or absence of palmitate (200 μmol/l). RT-PCR and Western blotting showed increased TNF-α expression in C2C12 myotubes treated with nicotine in the presence of palmitate. Furthermore, stimulation with nicotine in the presence of palmitate enhanced the production of reactive oxygen species (ROS) and activated the protein kinase C-nuclear factor-κB (PKC-NF-κB) pathway, as detected by dihydroethidium staining and Western blotting, respectively. Consequently, the translocation of GLUT4 to the plasma membrane as well as insulin-stimulated Akt phosphorylation was impaired, and glucose uptake to the myocytes was blocked. In addition, the production of ROS was suppressed by 4-hydroxy-TEMPO, and inhibition of GLUT4 translocation to the plasma membrane was canceled. These results suggest that in C2C12 myotubes, nicotine in the presence of palmitate enhanced the production of ROS and the expression of TNF-α through the PKC-NF-κB pathway; suppressed GLUT4 translocation to the plasma membrane; and impaired glucose uptake to cells. This pathway represents a possible mechanism by which smoking induces insulin resistance in the body.

The phenotype spectrum of Japanese multiple system atrophy

OBJECTIVE

This study aimed to determine the spectrum of pathological involvement of the striatonigral (StrN) and olivopontocerebellar (OPC) systems in Japanese patients with multiple system atrophy (MSA). This study also aimed to compare the pathological spectrum of Japanese MSA patients with the previously reported results in British MSA patients.

METHODS

A semiquantitative pathological analysis of 50 MSA patients' brains that were referred to the Brain Research Institute, Niigata University, Japan, was performed. The severity of neuronal cell loss was determined as previously described by the study from the Queen Square Brain Bank (QSBB), UK.

RESULTS

The mean neuronal cell loss score was significantly higher in the OPC area than in the basal ganglia sites examined, except the dorsolateral putamen. The relative prevalence of pathological phenotypes showed that 40% of cases had OPC-predominant pathology, 18% had StrN-predominant pathology and the remaining (42%) had equivalent StrN and OPC pathology. None of the MSA cases had coexistent Lewy bodies in the dorsal motor nucleus of the vagus and the substantia nigra.

CONCLUSIONS

In contrast to the previously reported results involving British patients' brains from the QSBB (OPC-predominant pathology 17%, StrN-predominant pathology 34%, equivalent StrN and OPC pathology 49%), the results of the present study showed more pathological involvement of the OPC system than of the StrN system. The rarity of Lewy bodies may underlie the phenotypic expression of Japanese MSA. The present observations reflect the disequilibrium in the phenotype distribution between the two populations.

Relationship between the Acid-Inhibitory Effects of Two Proton Pump Inhibitors and CYP2C19 Genotype in Japanese Subjects: A Randomized Two-Way Crossover Study

This two-way crossover study investigated possible differences between the proton pump inhibitors, omeprazole and rabeprazole, in their effect on gastric acid secretion in Japanese subjects with differing cytochrome P450, family 2, subfamily C, polypeptide 19 (CYP2C19) genotypes. A total of 23 Helicobacter pylori-negative healthy volunteers received omeprazole 20 mg/day and rabeprazole 10 mg/day. Each drug treatment was given for a continuous 7-day period allocated in random order, with an interval of at least 1 week between drug treatment periods to allow for wash-out. Intragastric pH was measured on days 1 and 7. Overall median intragastric pH levels at 7 and 8 h after the first administration were significantly higher with omeprazole. There was no significant difference in intragastric pH in homozygous extensive metabolizers, whereas intragastric pH was significantly higher with omeprazole in combined data from heterozygous extensive metabolizers and poor metabolizers at 6, 7 and 8 h after the first drug administration. There were no significant differences in intragastric pH between omeprazole and rabeprazole irrespective of genotype on day 7 of administration. In conclusion, on day 1 the time to onset of the antisecretory action of 20 mg/day omeprazole was more rapid than that of 10 mg/day rabeprazole in Japanese individuals who have a higher incidence of the CYP2C19 poor metabolizer genotype, however by day 7 no difference in antisecretory effect was found, regardless of genotype.

The palliative care knowledge test: reliability and validity of an instrument to measure palliative care knowledge among health professionals

Development of palliative care educational programmes continues in Japan. An instrument to evaluate a wider range of palliative care knowledge among general physicians and nurses is needed. However, such an instrument does not currently exist. The aim of this study was to develop an assessment to measure the efficacy of palliative care educational programmes. The questionnaire survey was validated with a group of 940 nurses at two facilities. The response rate was 85 % (n = 797). This study used psychometric methods such as item response theory and intraclass correlation coefficients. Ultimately, 20 items in 5 domains including 'philosophy', 'pain', 'dyspnoea', 'psychiatric problems' and 'gastrointestinal problems' were selected. For these items, the intraclass correlation was 0.88 overall and 0.61-0.82 in each domain; the Kuder-Richardson formula 20 in internal consistency was 0.81. Validity and reliability of the instrument were established. This tool is designed to evaluate a wider range of palliative care knowledge than currently available assessments and can be used for general physicians and nurses. The evaluation of educational programmes and the clarification of actual knowledge acquired are possible using this instrument.

Detrimental effects of glucocorticoids on neuronal migration during brain development

Glucocorticoids, the most downstream effectors of the hypothalamus-pituitary-adrenal axis, are one of main mediators of the stress reaction. Indeed, exposure to high levels of stress-triggered glucocorticoids is detrimental to brain development associated with abnormal behaviors in experimental animals and the risk of psychiatric disorders in humans. Despite the wealth of this knowledge, the cellular and molecular mechanisms underlying the detrimental effects of glucocorticoids on brain development remain unclear. Here, we show that excess glucocorticoids retard the radial migration of post-mitotic neurons during the development of the cerebral cortex, and identify an actin regulatory protein, caldesmon, as the glucocorticoids' main target. The upregulation of caldesmon expression is mediated by glucocorticoid receptor-dependent transcription of the CALD1 gene encoding caldesmon. This upregulated caldesmon negatively controls the function of myosin II, leading to changes in cell shape and migration. The depletion of caldesmon in vivo impairs radial migration. The overexpression of caldesmon also causes delayed radial migration during cortical development, mimicking the excessive glucocorticoid-induced retardation of radial migration. We conclude that an appropriate range of caldesmon expression is critical for radial migration, and that its overexpression induced by excess glucocorticoid retards radial migration during cortical development. Thus, this study provides a novel insight into the underlying mechanism of glucocorticoid-related neurodevelopmental disorders.

A case with spontaneous bladder rupture mimicking acute kidney injury

A 77-year-old female with abdominal pain and ascites was admitted to our hospital. She had a past history of the postoperative pelvic irradiation for uterine cancer and subsequently suffered from neurogenic bladder. On admission, serum creatinine (s-Cr) and blood urea nitrogen (BUN) were elevated to 9.9 mg/dl and 131 mg/dl, respectively. However, both the ratio of BUN/s-Cr and creatinine in ascites/s-Cr were significantly elevated. The clinical manifestations of the present case were not typical for acute kidney injury. Furthermore, 2 days after urethral catheterization, both s-Cr and BUN were normalized (0.69 mg/dl and 10 mg/dl, respectively) and her symptoms had improved immediately. Therefore, we diagnosed her disease as spontaneous bladder rupture. We report a case with spontaneous bladder rupture mimicking acute kidney injury forty years after postoperative pelvic irradiation for uterine cancer.

Ultrasonic propagation of a metallic domain in Pr0.5Ca0.5CoO3 undergoing a photoinduced insulator-metal transition

Femtosecond optical response was investigated on a perovskite-type cobalt oxide, Pr0.5Ca0.5CoO3 during an insulator-metal (I-M) transition accompanied with the change in spin configuration. After photoirradiation at 30 K, the reflectivity showed a sudden and large increase with subsequent variation depending on the observed photon energy. An exact calculation of Maxwell's equations for the Pr0.5Ca0.5CoO3 after the photoirradiation enabled us to observe the ultrafast dynamics of I-M phase transition and the motion of the photonically created metallic domain at the velocity of ultrasonic wave.

Molecular analyses of cell origin and detection of circulating tumor cells in the peripheral blood in alveolar soft part sarcoma

Alveolar soft part sarcoma (ASPS) is a distinct, rare soft tissue tumor with an unknown histogenesis and a tendency for late widespread metastases to lung, bone, and brain. It is now clear that they are caused by a specific unbalanced translocation, der(17)t(X;17)(p11;q25), which results in the formation of an ASPSCR1-TFE3 (alias ASPL-TFE3) fusion gene. The rearrangement results in the expression of chimeric transcripts, which can be identified by means of reverse transcriptase-polymerase chain reaction (RT-PCR). We investigated the histogenesis of ASPS and attempted to detect circulating ASPS tumor cells in peripheral blood. The immunohistochemical and genetic details of four cases and one cell line of ASPS were examined. An immunohistochemical analysis and RT-PCR did not detect myogenic differentiation gene MYOD1. The sensitivity of nested RT-PCR for detection of circulating ASPS cells was assessed by demonstrating that the tumor cell-associated gene translocation could be detected in 50 tumor cells/2 mL of blood. Clinically, it was detectable in a peripheral blood sample (2 mL) of ASPS patient with distant metastases. The findings suggest that ASPS is not of skeletal muscle origin. ASPS tumor cells in the peripheral blood could be monitored by RT-PCR.

Expression of bone morphogenetic proteins in giant cell tumor of bone

BACKGROUND

A giant cell tumor (GCT) of bone is a locally aggressive tumor with a propensity for local recurrence. A characteristic pattern of peripheral bone formation has been described in GCT recurrence in soft tissue, and in some pulmonary metastases from benign GCT. Although the bone formation in GCT in supposedly due to bone morphogenetic proteins (BMPs), the expression pattern of BMPs in GCT has not been well investigated.

MATERIALS AND METHODS

The expression of BMPs in GCT tissues, cultured stromal cells from GCT, and osteoclast-like giant cells harvested by laser microdissection (LM), as well as from control osteosarcoma (NOS-1) cells was analyzed using reverse transcriptional-semiquantitative PCR.

RESULTS

BMP 2, 3, 4, 5 and 6 were expressed in the GCT tissue. The cultured GCT cells expressed BMP 2, 4, 5 and 6. The osteoclast-like giant cells expressed BMP 2, 3, 5 and 6 and BMP 5 was expressed at the highest level.

CONCLUSION

Both stromal cells and osteoclast-like cells in GCT expressed several kinds of BMPs.

J-HOPE study: Evaluation of end-of-life cancer care in Japan from the perspective of bereaved family members

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Background: The Japan Hospice and Palliative Care Evaluation (J-HOPE) study was conducted in 2007 and 2008. The aim of the study was to evaluate the quality of end-of-life care at regional cancer centers (CCs), inpatient palliative care units (PCUs), and home hospices (HHs) in Japan from the perspective of bereaved family members. Methods: A nationwide cross-sectional mail survey was conducted in 2007 and 2008. The survey was sent to bereaved families 6–18 months after the death of a patient at 56 CCs, 100 PCUs, or 14 HHs. Outcome measures were the good death inventory, the care evaluation scale, and overall satisfaction with care. The protocol of this study was approved by the institutional review boards of each participating institution. Results: Of the 13,181 bereaved family members that received the survey, 8,163 (62%) participants returned their responses. Among bereaved family members, significantly fewer responded that patients were free from physical distress at CCs (50%) than PCUs (80%) and HHs (73%) (P<0.0001). Significantly fewer patients trusted the physicians at CCs (79%) when compared with PCUs (83%) and HHs (88%) (P<0.0001). Significantly fewer patients were valued as people at CCs (83%) than PCUs (93%) and HHs (95%) (P<0.0001). In addition, significantly fewer participants felt physicians should have worked to improve the patients' symptoms more quickly at CCs (55%) when compared with PCUs (78%) and HHs (77%) (P<0.0001). Significantly fewer participants felt nurse should improve their knowledge and skills regarding end-of-life care at CCs (51%) when compared with PCUs (76%) and HHs (78%) (P<0.0001). A total of 51% of participants reported that nurses should improve their knowledge and skills regarding end-of-life care. Finally, significantly fewer participants were satisfied with the end-of-life care provided by CCs (80%) when compared with PCUs (93%) and HHs (94%) (P<0.0001). Conclusions: Overall, the bereaved family members appreciated the end-of-life care provided by CCs, PCUs, and HHs in Japan. However, in some situations, the quality of end-of-life care provided by CCs was lower than that provided by PCUs and HHs.

No significant financial relationships to disclose.