Intraoperative radiotherapy for gliomas

Intraoperative radiotherapy (IORT) was performed in 20 of 36 patients with glioma; 11 glioblastomas, 7 malignant astrocytomas, 2 benign astrocytomas. Twenty or 25 Gy of irradiation was delivered in a single fraction intraoperatively, followed by external beam irradiation. The electron beam energy was selected so that the 80% isodose line fell at 2 or 3 cm below the residual tumor surface. Median survival time of IORT group was 14 months and that of the control group was 10 months. Difference of survival curve was significant. There were 6 incidences of complication caused by IORT; 1 radionecrosis, 1 convulsion, 1 abscess, and 3 severe brain edemas. IORT is suited for the treatment of malignant gliomas.

In vivo human myocardial metabolism during aerobic exercise by phosphorus-31 nuclear magnetic resonance spectroscopy

A few studies have been made in vivo on human myocardial energy metabolism. Hence, no discussion has taken place on metabolism during exercise or of training effects on metabolism. We examined human myocardial energy metabolism at rest and during exercise, and also training effects on the metabolism by phosphorus-31 nuclear magnetic resonance (31P NMR)-spectroscopy. Six sedentary male students (Cont) and six male long distance runners (Tr) were the subjects. Energy metabolism data were obtained from myocardium during rest and exercise by the region selection method using 31P NMR. Rotation of the legs while riding a bicycle, which was fitted with an ergometer we had made ourselves for NMR, imposed given exercise intensities. The heart rate was measured in a stationary phase during exercise. Although the heart rate at rest in the Tr group was significantly lower [Tr, 52.5 (SD 3.1) beat.min-1; Cont, 67.1 (SD 2.9) beat.min-1], no significant difference was observed in myocardial energy metabolism using the 31P NMR method [Tr, phosphocreatine/beta-adenosine 5'-triphosphate (PCr/beta-ATP); 1.51 (SD 0.02); Cont, 1.51 (SD 0.01)]. When NMR measurements were investigated at two different intensities of exercise, heart rates in the Cont group were significantly higher by about 20 beat.min-1 than those in the Tr group at both exercise intensities, while no difference in energy metabolism was observed between the groups or between rest and exercise [Tr, 75.9 (SD 3.6), 88.3 (SD 3.7) beat.min-1; PCr/beta-ATP 1.51 (SD 0.03), 1.51 (SD 0.03); Cont, 95.9 (SD 2.4), 115.1 (SD 3.5) beat.min-1, PCr/beta-ATP 1.51 (SD 0.01), 1.51 (SD 0.04)].(ABSTRACT TRUNCATED AT 250 WORDS)

Periodic maternal deprivation alters stress response in adult offspring: potentiates the negative feedback regulation of restraint stress-induced adrenocortical response and reduces the frequencies of open field-induced behaviors

The effects of periodic maternal deprivation (PMD) treatment on the adrenocortical stress response and on open-field behavior in adult offspring were investigated. Sprague-Dawley rat pups were deprived of mothers daily for 4.5 h during the first 3 weeks of life. PMD treatment resulted in lower corticosterone levels during restraint stress later in life. The result of dexamethasone suppression test indicated that PMD treatment caused a potentiation of the negative feedback function of adrenocortical response. These effects of PMD were not accompanied by an increased density of the hippocampal glucocorticoid receptor which has been reported to be induced in neonatal handling treatment (brief 15-min maternal deprivation). Serotonin (5-HT)-2 and beta-adrenergic binding sites were also examined in cerebral cortex and no change of binding capacities were induced by PMD treatment. In the open-field test, PMD treatment decreased the number of ambulations and rearings but did not affect a frequency of defecation. From these results, it is suggested that PMD treatment leads rats to be insensitive to environmental stimuli in adulthood.

Modulatory effects of calcitonin gene-related peptide and substance P on human cholinergic sweat secretion

Immunoreactivity to various peptides has been demonstrated in nerve terminals around the sweat glands, suggesting a regulatory function for these peptides on sweating. The present study evaluated the calcitonin-gene related peptide and substance P related regulation of sweating in man. Both calcitonin-gene related peptide and substance P, when administered alone, failed to cause sweat secretion, whereas sweating induced by methacholine chloride alone was four times greater when administered with calcitonin-gene related peptide and suppressed by 70% when administered with substance P. The degree of calcitonin-gene related peptide dependent augmentation and substance P dependent suppression of the methacholine chloride induced sweating was dependent on the concentration of calcitonin-gene related peptide and substance P. These findings suggest that calcitonin-gene related peptide enhances cholinergic sweating and substance P inhibits it.

[Longitudinal analysis of glucose metabolism in recurrent meningioma]

We repeatedly measured kinetic rate constants and glucose metabolic rate (kinetic rCMRG1) using dynamic positron emission tomography (PET) and autoradiographic rCMRG1 in a patient with recurrent meningioma. A 50-year-old woman who presented with a left visual disturbance was admitted to our hospital. MR images revealed a mass lesion occupying the left middle fossa. The patient underwent Simpson grade IV surgery. The histological diagnosis was meningothelial meningioma. One year later the tumor had grown back to almost the same size as before treatment and was removed again by Simpson grade IV procedure. Postoperatively, the patient underwent radiation therapy (54 Gy). Two years after the second operation, the tumor was found to have invaded the left orbit and was resected by Simpson grade IV procedure. After additional radiation therapy, the patient was discharged. The rate constants were analyzed preoperatively and whenever the tumor recurred according to the three compartment 18F-fluorodeoxyglucose (FDG) model. Preoperative PET indicated tumor k1 and k2 values higher than in the contralateral gray matter, suggesting high permeability due to absence of the blood-tumor barrier and an abundant blood supply. The tumor k3 value, an indicator of hexokinase activity, was as high as in the contralateral gray matter. When the tumor recurred, the tumor k1, k2 and k3 values remained consistently high, indicating high proliferative activity. In contrast, the contralateral gray matter k1, k2 and k3 values decreased to some extent, suggesting effects of surgery or radiotherapy. Tumor rCMRG1 values, both autoradiographic and kinetic, were enhanced markedly.(ABSTRACT TRUNCATED AT 250 WORDS)

The potential protective immune responses to synthetic peptides containing conserved epitopes of Porphyromonas gingivalis fimbrial protein

The immunodominant and T-cell epitopes within the fimbrial subunit protein (fimbrilin) of Porphyromonas gingivalis strain 381 were analysed by multi-pin peptide synthesis technology. Six regions with immunodominant epitopes within a sequence of 337 amino acids that reacted with the serum of patients with adult periodontitis were detected. T cells from mice immunised with P. gingivalis fimbriae exhibited proliferative responses to P. gingivalis fimbriae or to six 10-mer synthetic peptides from the amino-acid sequence of the fimbrillin. Three synthetic peptides that contained the regions responsible for the immunodominant epitopes as well as those which coincided with a T-cell epitope of P. gingivalis fimbrial molecules--FP38 (142-161), FP381(202-221) and FP381(216-243)--were selected and synthesised. When guinea-pigs were immunised with fimbriae or one of the three synthetic peptide segments and an adjuvant in Freund's incomplete adjuvant, enhanced production of the antigen-specific IgG antibodies was induced in the serum of the animals. Furthermore, of the three synthetic peptides tested, FP381(202-221) produced the greatest protective immune response in guinea-pigs infected with P. gingivalis and this was more effective than the native fimbrial protein.

Effects of exercise training on alpha-adrenergic mediated pressor responses and baroreflex function in older subjects

Endurance exercise training increases maximal O2 uptake (VO2max) in older subjects, and training also improves cardiac function in older men. Although the effects of training on beta-adrenergic responses have been investigated, little information is available regarding the effects of alpha-adrenergic responses and baroreflex function in older men and women. The purpose of the study was to determine whether endurance exercise training can affect alpha-adrenergic responses and baroreflex function in the elderly. We studied 13 men and women, 63 +/- 4 yrs old (mean +/- SE). VO2max was determined during treadmill exercise. Baroreflex function was determined from the change in heart rate (HR) relative to the change in systolic blood pressure (delta HR/delta SBP) during infusion of phenylephrine. VO2max was increased by 23% (1.9 +/- 0.16 vs 2.34 +/- 0.20 l/min; p < .01) in response to training. Maximal heart rate did not change, but HR during submaximal exercise at the same absolute exercise intensity was 17% lower after training. Resting heart rate was slower in the trained state. During alpha-adrenergic stimulation induced by graded doses of phenylephrine infusion, heart rate was lower after training because of training-induced bradycardia at rest. However, the elevation in systolic blood pressure (delta SBP) and mean blood pressure (delta MBP) from basal levels in response to a given dose of phenylephrine were significantly larger (delta SBP:18 +/- 3 vs 26 +/- 3 mmHg, p < .01; and delta MBP 10 +/- 2 vs 15 +/- 3 mmHg, p < .01) after than before training.(ABSTRACT TRUNCATED AT 250 WORDS)

MR of acute subarachnoid hemorrhage: a preliminary report of fluid-attenuated inversion-recovery pulse sequences

We report preliminary results applying fluid-attenuated inversion-recovery (FLAIR) sequences to three patients with acute subarachnoid hemorrhage. Acute subarachnoid hemorrhage could be clearly demonstrated as areas of high signal intensity on FLAIR sequences in all patients. These preliminary results suggest that with FLAIR sequences one could reliably diagnose acute subarachnoid hemorrhage.

Regulation of basal release of GABA by noradrenaline in the kitten visual cortex

To determine the modulatory effect of noradrenaline (NA) on basal release of gamma-aminobutyric acid (GABA), we measured the extracellular GABA with a brain microdialysis technique in the kitten visual cortex. Local infusion of NA through a cannula, which was implanted 2 mm away from the dialysis probe, gave rise to a marked increase in GABA release. This NA-induced GABA release was suppressed by tetrodotoxin, a sodium channel blocker, which was perfused at the probe site. The effect of NA was antagonized by pretreatment with metoprolol, a beta 1-selective antagonist. These results suggest that the cortical noradrenergic system may be involved in the regulation of basal GABA release that is possibly due to the activity of inhibitory neurones in the kitten visual cortex.

Total synthesis of a modified ganglioside, de-N-acetyl GM2

Regio- and stereo-selective glycosylation of a sialyl donor 6 that carries a N-phthaloyl protecting group at C-5 with a lactosyl acceptor 7 armed with a pivaloyl group at O-2a was performed to give the expected glycotrioside 5. Subsequent glycosylation of 5 with 2-azido galactosyl donor 4 gave glycotetraosyl derivatives 18 and 19. After conversion of 18 into imidates 25 and 26, coupling with (2S,3R,4E)-3-O-benzoyl-2-N-tetracosanoylsphingenine (2) was executed to afford completely protected ganglioside analogues 27 and 28. Selective cleavage of the methyl ester and N,O-deprotection gave the target de-N-acetyl GM2 (1).

[An epidemiologic research design using the Annual of the Pathological Autopsy Cases in Japan]

Epidemiologic research designs using the Annual of the Pathological Autopsy Cases in Japan (APAC hereinafter) are discussed in this paper. The APAC data base has been recommended for use in epidemiologic research. However, it has not often been utilized for such research, even though it covers all pathological autopsy cases in Japan, perhaps because of different sampling proportions of each disease and because of the dead control series in APAC. First, we present epidemiologic measures in using the APAC. We show that the data base can be treated as a case-control design and that the magnitude of the exposure effect should be estimated by an odds ratio. Next, selection bias and information bias in using the APAC are discussed. The independence of the control series from the exposure is important in the determination of the control disease. Because this design is based on internal comparison, non-differential misclassification should be stressed more than differential misclassification.

[Circulation time determined by carotid angiography in patients with chronic internal carotid artery occlusion: comparison with cerebral blood flow and oxygen metabolism measured by PET]

The degree of collateral circulation in patients with unilaterally chronic internal carotid artery occlusion was estimated by mean transit time of contrast material in rapid sequence carotid angiography (Angiographic MTT), and compared with cerebral blood flow and oxygen metabolism measured by PET. In normal density region on X-ray CT, a significant negative correlation was observed between Angiographic MTT and cerebral blood flow (CBF). This indicates that cerebral blood flow can be estimated by Angiographic MTT. It has been reported that the ratio of cerebral blood volume (CBV) to CBF (CBV/CBF), i.e., mean transit time determined by PET well agreed with OEF, and is good indicator for brain circulation reserve. In this study, no significant correlation was observed between Angiographic MTT and CBV/CBF. However, a significant positive correlation was observed between Angiographic MTT and oxygen extraction fraction (OEF), and no significant correlation was observed between Angiographic MTT and oxygen consumption rate (CMRO2). These indicates that Angiographic MTT may be indicator for brain circulation reserve.

Chemotaxis of human monocytes by synthetic peptides that mimic segments of Porphyromonas gingivalis fimbrial protein

Porphyromonas gingivalis strain 381 fimbriae and their synthetic peptide segments were assessed for migration-stimulating activity on human peripheral blood monocytes by multiwell chemotaxis assay. P. gingivalis 381 fimbrial protein was found to markedly enhance migration of human monocytes. The observed increase in monocyte migration occurred mainly directed toward a positive stimulus (chemotaxis). Furthermore, lipopolysaccharides extracted from P. gingivalis 381 were shown to induce chemotaxis and chemokinesis. It was also revealed that the migration of monocytes was increased by specific synthetic peptide segments, FP381(61-80) and FP381(171-185), that correspond to GKTLAEVKALTTELTAENQE and DANYLTGSLTTFNGA, respectively, based on the amino acid sequence of the fimbrial subunit protein proposed by Dickinson et al., and the migration stimulation was ascribed to chemotaxis. Furthermore, within the amino acid sequences, the LTXXLTXXN sequence may play an important role in binding the organisms to monocytes and macrophages and in the induction of migration-stimulating activity.

[Lung resection for lung carcinoma with idiopathic interstitial pneumonia]

Of 12 patients who underwent lung resections for lung cancer with idiopathic interstitial pneumonia (IIP), eight patients survived and four patients died due to acute exacerbation of IIP after the operation. The preoperative values for percent forced vital capacity, predicted postoperative percent vital capacity, percent one-second forced expiratory volume index and serum level of C-reactive protein were significantly different between the group of patients who survived and that of having died. Three days after the operation, the percentage of lymphocytes among leukocytes and serum level of lactate dehydrogenase in the two groups were both significantly different. These findings showed that the operative strategy for patients with lung cancer and IIP needs specifically careful consideration for operative procedure, and preoperative serum levels of C-reactive protein and postoperative lactate dehydrogenase and the percentage of lymphocytes in leukocytes would be useful in evaluation of the severity of IIP.

Transforming growth factor-beta-1 reduces alkaline phosphatase mRNA and activity and stimulates cell proliferation in cultures of human pulp cells

Transforming growth factor-beta-1 (TGF-beta-1) is a potent modulator of proliferation and differentiation in various tissues, and may be involved in the control of dental development and repair. This study was carried out to investigate the effects of TGF-beta-1 on alkaline phosphatase (ALPase) activity and mRNA level, and on DNA content in cultures of human pulp cells. Four lines of pulp cells (P1-P4), isolated from the upper wisdom teeth of four patients, were maintained separately in monolayer cultures in the presence of 10% fetal bovine serum. TGF-beta-1, at 0.1 ng/mL, increased ALPase activity and DNA content in P1 cultures, but not in P2-P4 cultures. In all cultures, TGF-beta-1, at 5 ng/mL, decreased ALPase activity to a very low level, and increased DNA content. Northern analysis showed that human pulp cells synthesized a single species of 2.6-kb liver/bone/kidney-type ALPase, and that TGF-beta-1, at 5 ng/mL, decreased the level of the ALPase mRNA. These results suggest that TGF-beta-1 is a mitogen for human pulp cells, and that it regulates the activity of the universal-type ALPase at the pre-translational level.

[Anthropophobia: psychopathological approach to the interactions between body, inter-subjectivity and language]

Anthropophobia is the general term often taken as an equivalent to social phobia which comprises the several afflictions known in Europe under names like autodysosmophobia, scopophobia, erythrophobia, and olfactory reference syndrome, among others. Following a general introduction to anthropophobia, we will use three short observations to illustrate a phenomenological approach which shows both the confusion between the two dimensions of corpority and intersubjectivity and the specific relations joining body and language that are characteristic of this pathology. In addition to that, a psychoanalytical insight shows that anthropophobic patients possess traits that are specific to the intrusion complex and that reveal an evolutionary stage between narcissism and Oedipian phases.

Prevalence of thyroid hormone autoantibodies in healthy subjects

OBJECTIVE

The prevalence of thyroid hormone autoantibodies in patients with thyroid disorders has been well described, although the results have been variable. However, the prevalence of thyroid hormone autoantibodies in apparently healthy subjects remains unknown and its determination was the main objective of this study.

SUBJECTS AND METHODS

Sera obtained from 880 healthy subjects (365 men and 515 women) were examined for thyroid hormone autoantibodies by immune precipitation using radiolabelled thyroid hormones or thyroid hormone analogues.

RESULTS

Anti-triiodothyronine (T3) and anti-thyroxine (T4) antibodies were detected in none (0%) and in 3 (0.34%), respectively, of the 880 individuals studied using radiolabelled thyroid hormones. Similar tests in 385 healthy subjects using radiolabelled thyroid hormone analogues (polyaminocarboxy T3 and T4) showed the presence of anti-T3 and anti-T4 antibodies in 3 (0.78%) and in 4 (1.04%), respectively. None of the subjects had both anti-T3 and anti-T4 antibodies. Thus, the prevalence of anti-T3 or anti-T4 antibodies among healthy population was concluded to be as high as 1.8%. Radiolabelled thyroid hormone analogue binding to purified immunoglobulin G (IgG), with or without the addition of an excess of unlabelled thyroid hormones, confirmed specific binding of thyroid hormones to the thyroid hormone autoantibody-positive IgGs. The presence and class specificity of thyroid hormone autoantibodies was confirmed by the Ouchterlony immunodiffusion/autoradiography method, which showed biphenotypic heavy chain (IgG and IgA) and kappa (kappa) light chain specificities. Serum concentrations of free thyroid hormones and TSH in thyroid hormone autoantibody-positive sera were within the normal range.

CONCLUSIONS

These results indicate that the occurrence of thyroid hormone autoantibodies among the healthy Japanese population is fairly common. However, interference of thyroid hormone autoantibodies in the radioimmunoassay of free thyroid hormones is exceptional.

Suppression of IgA production by lymphocytes induced by diphenylhydantoin

In this study, the mechanisms for suppression of immunoglobulin production by lymphocytes induced by diphenylhydantoin (DPH) were investigated using peripheral blood mononuclear cells from one patient 3 months after discontinuation of DPH, when IgA deficiency was improved. Immunoglobulin production in PBMCs was dose-dependently suppressed by DPH and the suppressive effect of DPH on IgA production tended to be greater than the effect on IgM or IgG production. Moreover, cell separation experiments indicated that DPH suppresses immunoglobulin production by PBMCs through a suppression of B cell, but not T cell, function. The finding that the suppressive effect of DPH on IgA production tended to be greater than the effect on IgM or IgG production might be related to the fact that the alpha-chain gene is located in the 3' end of the gene coding the constant regions of human heavy chains.

Pharmacokinetic properties of E3810, a new proton pump inhibitor, in healthy male volunteers

E3810 is a new H+,K(+)-ATPase inhibitor with a substituted benzimidazole, which is under clinical investigation for peptic ulcer treatment in Japan and the USA. Three separate studies were conducted to evaluate the safety and to establish the pharmacokinetic profile of E3810 after oral administration to healthy male subjects. E3810 was administered as: single oral doses (1, 3, 10, 20, 40 and 80 mg) in fasting conditions, a single oral dose (20 mg) after a meal and repeated oral doses (20 and 40 mg) once daily for 7 days. The concentrations of E3810 and its metabolites in plasma and urine were determined by HPLC methods with UV detection. E3810 was generally well tolerated by all subjects. In the single-dose study, Cmax and AUC increased with increasing doses in the dose range examined. The mean plasma half-life was about 1.0 hour and was dose-independent. The apparent oral clearance of E3810 ranged from 4.37 to 8.40 ml/min/kg. No significant deviation from linear pharmacokinetics was observed. Approximately, 30% of a dose was excreted into the urine as thioether carboxylic acid-E3810 and its glucuronide. The mean serum protein binding was 96.3%. No effect of food intake on the Cmax and AUC was observed while tmax after a meal was 1.7 hours longer than that in the fasting conditions. No appreciable change in drug pharmacokinetics was observed during repeated oral dosing of E3810.