[Comparative study of the efficacy of plasma exchange, immunoadsorption plasmapheresis and corticosteroid administration in the treatment of Guillain-Barré syndrome]

We have retrospectively compared the efficacy of plasma exchange (PE), immunoadsorption plasmapheresis therapy (IAPP), corticosteroid administration and no treatment in the treatment of the Guillain-Barré Syndrome (GBS). Forty-two patients with GBS and clinical functional grades of more than Hughes 3 were admitted to Shinshu University Hospital, Nagano Red-cross Hospital and Saku General Hospital between 1978 and 1994. These patients were treated with either PE, IAPP, corticosteroids or no therapy. Eight were treated with PE, eleven with IAPP, twelve with corticosteroids and eleven were untreated. None of the patients were received combined therapy. The four groups of patients were compared on the following points; duration of the deteliocation in symptoms, duration of the worst symptoms, period of the ability to walk after onset, minimum motor nerve conduction velocity (MCV) over the course, maximum cerebrospinal fluid (CSF) protein concentration over the course, and CSF protein concentration improvement 6 weeks after onset as compared with 2 weeks after onset. The results revealed that the duration of the worst symptoms was shortened more in the IAPP-treated and PE-treated groups than in the other groups. Decreases in CSF protein concentration were more significant in the IAPP-treated and PE-treated groups than in the other groups. There were no significant differences in the other parameters among the groups. Furthermore the clinical symptoms of GBS improved more rapidly with PE and IAPP than with supportive care alone or corticosteroid therapy, especially in the early phase of the disease. IAPP and PE are equally effective.(ABSTRACT TRUNCATED AT 250 WORDS)

[A left-handed patient with disturbance of manipulating objects]

We reported a left-handed patient with the disturbance of manipulating objects and the object pantomime. The patient was a 72-year-old man, admitted to Osaka Medical College Hospital complaint of the difficulty of object manipulation. The patient was alert, well oriented and attentive. On neurological examination the patient revealed grasp reflex in his left hand. On neuropsychological examination the patient spoke fluently, but his verbal comprehension was slightly disturbed. He could name popular objects only 9 out of 20 objects. On praxis examination he could pantomime the socially accustomed movements by command visually pantomime. He did not reveal buccofacial apraxia and constructional apraxia. However, the patient could not manipulate both single and pleural objects actually and pantomime without objects. On MRI the lesion was found in both frontal lobe, right medial frontal lobe and right temporal lobe. SPECT findings demonstrated that the bilateral parietal lobes were preserved and we speculated that the right supplementary motor area was assumed to be a crucial lesion for manipulating objects in the patient.

Tenascin-C induction in Whitlock-Witte culture: a relevant role of the thiol moiety in lymphoid-lineage differentiation

The extracellular matrix (ECM) glycoprotein tenascin-C is expressed in a temporally and spatially restricted pattern during embryogenesis and carcinogenesis in association with stromal-epithelial interactions. First, we investigated the production of tenascin-C and other ECM glycoproteins in the established in vitro model system specific for the lymphoid-lineage hemopoiesis, i.e., the Whitlock-Witte (W-W) culture system. In murine primary long-term bone marrow cultures, tenascin-C was produced constitutively and was expressed significantly in higher amounts in this system than in the other established in vitro model system specific for the myeloid-lineage hemopoiesis, i.e., the Dexter culture system. 2-Mercaptoethanol (2-ME), a component of the W-W system, induced the secretion of tenascin-C and upregulated the expression of its mRNA. Furthermore, the reduced glutathione, which, like 2-ME, contains a thiol moiety, induced tenascin-C glycoprotein and its mRNA. By contrast, hydrocortisone (HC), a component of the Dexter system, inhibited the secretion of ECM glycoproteins. 2-ME and TGF-beta 1, the latter of which is known as an inducer of ECM glycoproteins, had an additive effect on the induction of tenascin-C when they were simultaneously added to the W-W system. The TGF-beta receptor binding analysis demonstrated that this induction by 2-ME was not mediated by the cell-surface TGF-beta receptors, suggesting that it was regulated independently of TGF-beta 1. Then, the role of thiol compounds in the lymphoid-lineage differentiation was examined. The omission of 2-ME from the W-W system completely eliminated its ability to support the lymphoid-lineage differentiation. Glutathione, which, unlike 2-ME, does not passively permeate through the plasma membrane, did not support the development of a lymphoid lineage. These results indicate that 2-ME, essential for the lymphoid-lineage differentiation in the W-W culture system, is a potent inducer of tenascin-C expression in vitro.

The nerve supply to coracobrachialis in apes

The origin of the nerve supply to coracobrachialis from the brachial plexus in apes was investigated in 4 arms from 4 chimpanzees, both arms of a gorilla and 4 arms from 4 gibbons. The general architecture of the brachial plexus was the same as in the human. In the apes examined, the nerves supplying this muscle could be classified into 2 groups: (1) distal branches arising from the musculocutaneous nerve, and (2) proximal branches arising in the region of the lateral cord. On the basis of their origin and course, the proximal branches were classified into 3 types, namely a deep ramus arising from the middle trunk and passing dorsal to the upper trunk, a medial ramus arising from the upper trunk in the lateral cord, and a superficial ramus arising from the ventral surface of the middle trunk or the root of the pectoral nerve. This classification also applies to branches to coracobrachialis in man. The 3 types of proximal branch often communicated with each other to supply coracobrachialis, whereas the proximal and distal branches were separated from each other spatially. This indicates that coracobrachialis possesses characteristics both of the pectoral girdle muscles and the flexor muscles of the upper arm.

Epidermal growth factor enhances repair of rat intestinal mucosa damaged by oral administration of methotrexate

To examine the trophic effect of epidermal growth factor on the rat small intestine, we measured diamine oxidase and ornithine decarboxylase activities in intestinal mucosa injured by methotrexate. Methotrexate was infused orally via a gastric tube at a dose of 10 mg/kg per day on 3 successive days (days 1-3). Epidermal growth factor was injected intraperitoneally at a dose of 40 micrograms/kg per day on 4 successive days following methotrexate infusion (days 4-7). Methotrexate caused a marked decrease in diamine oxidase activity; this decrease returned to a normal level on day 13 in controls. In rats injected with epidermal growth factor, diamine oxidase activity began to recover earlier than in the controls, and returned to a normal level on day 11. Epidermal growth factor enhanced the increase of ornithine decarboxylase activity in mucosa injured by methotrexate. When the increase of ornithine decarboxylase activity was suppressed by alpha-difluoromethylornithine, epidermal growth factor failed to facilitate the repair of intestinal mucosa. These results indicate that epidermal growth factor enhances intestinal repair following methotrexate infusion, and that this effect is mediated, at least in part, by ornithine decarboxylase. It is proposed that epidermal growth factor can be used clinically as a means to enhance mucosal repair of the intestine after chemotherapy with methotrexate.

Continuous retrograde cerebral perfusion aids repair of aortic laceration during sternal re-entry

We successfully repaired an anticipated large laceration of the ascending aorta occurring during sternal re-entry in a 68-year old woman undergoing replacement of a prosthetic aortic valve. Cerebral protection was ensured by using continuous retrograde cerebral perfusion via femoro-femoral bypass with deep hypothermia. The cooling time was 20 minutes. The minimum nasopharyngeal temperature was 15 degrees C and the duration of the retrograde perfusion was 11 minutes at a rate of 600 ml per minute. The postoperative course was uneventful and no neurological deficits occurred.

Pharmacological effects of dai-saiko-to on lipid biosynthesis in cultured human hepatocyte HepG2 cells

The pharmacological effects of Dai-saiko-to, a Japanese and Chinese traditional medicinal mixture (Kampohozai), on lipid biosynthesis were investigated in cultured human hepatocyte HepG2 cells. The addition of Dai-saiko-to (0.5 mg/ml), which had no significant effect on cell proliferation, caused a marked decrease in the intracellular triglyceride content with no significant changes in the other lipid fraction. At the same time, the incorporation of 14C-acetate or 3H-glycerol into the triglyceride or diglyceride fractions also decreased significantly. These results suggest that Dai-saiko-to decreases hepatic triglyceride biosynthesis, which might contribute to a reduction in plasma VLDL levels.

Molecular cloning, sequencing, and expression of the genes encoding adenosylcobalamin-dependent diol dehydrase of Klebsiella oxytoca

The pdd genes encoding adenosylcobalamin-dependent diol dehydrase of Klebsiella oxytoca were cloned by using a synthetic oligodeoxyribonucleotide as a hybridization probe followed by measuring the enzyme activity of each clone. Five clones of Escherichia coli exhibited diol dehydrase activity. At least one of them was shown to express diol dehydrase genes under control of their own promoter. Sequence analysis of the DNA fragments found in common in the inserts of these five clones and the flanking regions revealed four open reading frames separated by 10-18 base pairs. The sequential three open reading frames from the second to the fourth (pddA, pddB, and pddC genes) encoded polypeptides of 554, 224, and 173 amino acid residues with predicted molecular weights of 60,348 (alpha), 24,113 (beta), and 19,173 (gamma), respectively. Overexpression of these three genes in E. coli produced more than 50-fold higher level of functional apodiol dehydrase than that in K. oxytoca. The recombinant enzyme was indistinguishable from the wild-type one of K. oxytoca by the criteria of polyacrylamide gel electrophoretic and immunochemical properties. It was thus concluded that these three gene products are the subunits of functional diol dehydrase. Comparisons of the deduced amino acid sequences of the three subunits with other proteins failed to reveal any apparent homology.

[Reviews on biochemical markers of lead exposure with special emphasis on heme and nucleotide metabolisms]

Biochemical marker in heme and nucleotide metabolisms were reviewed and evaluated in terms of biological monitoring of lead exposure. Analytical methods, reference values, threshold values, dose-effect relationships, validity, applicable range of Pb-B levels, and confounding factors were studied for the biochemical parameters: delta-aminolevulinic acid dehydratase activity (ALA-D), delta-aminolevulinic acid in plasma (ALA-P), delta-aminolevulinic acid in urine (ALA-U), coproporphyrin in urine (CP-U), erythrocyte protoporphyrin (EP) or zinc protoporphyrin (ZP), pyrimidine 5'-nucleotidase (P5N), and pyrimidine nucleotides in blood (PN). The threshold value of Pb-B for ALA-D by CEC method or restoration method was 5 micrograms/dl. The high validity (> 1.8) was found at a wide range of Pb-B levels between 5 and 50 micrograms/dl, while that of ALA-D activity by CEC method was between 20 and 50 micrograms/dl. The threshold value of Pb-B for ALA-P was also as low as 5 micrograms/dl, and that for ALA-U (corrected for creatinine) was between 15 and 30 micrograms/dl or 20 and 40 micrograms/dl in HPLC or colormetric method, respectively. ALA-P showed a high validity (> 1.8) at Pb-B levels of 30 and 60 micrograms/dl, whereas ALA-U did at Pb-B of 60 micrograms/dl alone. EP (ZP) and CP-U were significantly increased in the Pb-B levels higher than 20 to 30 micrograms/dl and 40 micrograms/dl, respectively. The threshold level of Pb-B for P5N activity was less than 10 micrograms/dl, and showed a linear reduction in activity with a rise in Pb-B values between 10 and 60 micrograms/dl. The validity of P5N (1.86 at a cut off of < 10 mumol/h/g Hb) was the highest among biochemical parameters examined at Pb-B values over 40 micrograms/dl. PN was increased in the Pb-B levels higher than 60 micrograms/dl. Individual variation of ALA-U, CP-U, and ZP were relatively larger than those of PN. ALA-P seemed to be one of the most desirable biomarkers for lead exposure, because of simplicity, sensitivity and specificity of analytical method, and of wide range of applicable Pb-B, from normal to intoxication levels. PN might be of diagnostic value for lead intoxication. Lead effect or intoxication could be assessed more exactly by the combination of some specific biomarkers mentioned above.

Evaluation of optimal voltage-sensitive dyes for optical monitoring of embryonic neural activity

To evaluate the suitability of a variety of fast voltage-sensitive dyes for optical recording of rapid transmembrane potential activity in the embryonic nervous system, we screened over twenty dyes, including several newly synthesized probes, in three different embryonic neural preparations: cervical vagus nerve bundle, nodose ganglion, and brainstem from 7-day old chick embryos. Measurements of voltage-related optical signals were made using a multiple-site optical recording system. Signal size, signal-to-noise ratio, photobleaching, and phototoxicity were examined. Several promising new merocyanine-rhodanine dyes for embryonic nervous systems were found.

Cytoplasmic body myopathy with hypertrophic cardiomyopathy

A patient with cytoplasmic body myopathy presented muscle hypotonia from birth and developed progressive muscular atrophy and weakness, scoliosis, contracture of joints and cardiorespiratory failure. At the age of 17, he died of heart failure. Post mortem examination revealed severe hypertrophy of cardiac walls and generalized muscular atrophy. Microscopic examination showed many cytoplasmic bodies in skeletal muscle fibers and myofiber disarray in myocardium. No cases of cytoplasmic body myopathy with hypertrophic cardiomyopathy have been reported previously. It is suggested that the Z-line component is related to the formation of the cytoplasmic body in skeletal muscle and disarray in the cardiac muscle.

The diversity of T-cell receptor repertoire of peripheral CD4+ lymphocytes in LEC mutant rats

A novel mutant strain of rats, LEC, exhibits an arrest of T-cell maturation from CD4+CD8+ to CD4+CD8- but not the CD4-CD8+ cells in the thymus. Nevertheless, CD4+T cells arise in lymph nodes of LEC rats, implying extrathymic T-cell maturation. We analyzed the variable (V) and junctional region diversity of T-cell receptor (TCR) beta- chains in this population, since several reports have provided evidence that extrathymically matured T cells exhibit a biased expression of the TCR repertoire. CD4+ T cells in LEC rat lymph nodes exhibited a polymorphic V beta gene expression pattern. However, biased V beta gene expression was not identified in peripheral CD4+ T cells of LEC rats when compared with V beta gene expression in their thymocytes. Furthermore, junctional regions of TCR beta chains exhibited a vast diversity created by non-germline- encoded nucleotide (N nucleotide) additions. These results indicate that peripheral CD4+ T cells in LEC rats possess a vast diversity in the TCR repertoire as do thymocytes of the same rat, suggesting that they derive from the thymus.

Responses to glossopharyngeal stimulus in the early embryonic chick brainstem: spatiotemporal patterns in three dimensions from repeated multiple-site optical recording of electrical activity

In an effort to assess the spatial patterning of glossopharyngeal responses in the early embryonic chick brainstem, we used a multiple-site optical recording system with a 12 x 12 element photodiode array and a voltage-sensitive merocyanine-rhodanine dye (NK2761) to monitor neural transmembrane voltage activities. Seven and 8 d old embryonic chick brainstems were sliced into 1400-1600 microns thick sections with the glossopharyngeal and vagal nerves attached, and then stained with the dye. Neural voltage-related optical signals were evoked by a positive brief (depolarizing) square current pulse applied to the glossopharyngeal nerve with a microsuction electrode, and then recorded simultaneously from many loci in the objective two-dimensional image plane of a compound microscope. In addition to the multiple-site optical recording technique, we tried to introduce an optical sectioning method by changing the focal plane of the microscope to obtain three-dimensional information. Thus, we have been able to assess semiquantitatively the three-dimensional profiles of two glossopharyngeal response areas corresponding to the nucleus of the glossopharyngeal nerve (nucleus nervi glossopharyngei) and the nucleus of the tractus solitarius. Furthermore, glutaminergic excitatory postsynaptic potentials were determined within the response area corresponding to the nucleus of the tractus solitarius. In addition, we also compared the glossopharyngeal and vagal response areas and found that the cores of the related nuclei are separated in three dimensions.

Hair mercury concentrations in cats and dogs in central Japan

Hair mercury concentrations were measured in 41 cats and 34 dogs living in Kanagawa, Saitama and Tokyo Prefectures. Total mercury concentrations measured by atomic absorption spectrometry were significantly higher (P < 0.01) in cats [7.40 parts per million (ppm) in males and 7.45 ppm in females] than in dogs (0.99 ppm in males and 0.66 ppm in females). Mercury in cat hair was correlated with age (P < 0.01) and higher in cats fed with foods prepared by the owners than in those fed with commercial pet foods. Mercury concentrations in the animals' foods were markedly higher in fresh tuna (0.153 ppm) than in commercial pet foods (0.008-0.014 ppm).

A new simultaneous 1020-site optical recording system for monitoring neural activity using voltage-sensitive dyes

We have constructed a new 1020-site optical system for simultaneous recording of transmembrane electrical activity, using a 34 x 34-element photodiode array. This new apparatus permits analyses of the spatio-temporal pattern of neural activity, such as action potentials and postsynaptic potentials, in the central nervous system, at higher spatial and temporal resolutions.

Congenital triventricular hydrocephalus associated with a small lipoma in the quadrigeminal plate cistern

A case of neonatal congenital triventricular hydrocephalus due to a small intracranial lipoma in the quadrigeminal plate cistern is reported. The patient was treated by a ventriculoperitoneal shunt. The mechanism of obstructive hydrocephalus caused by the intracranial lipoma is discussed.

[Metabolism of lomerizine hydrochloride (KB-2796) in rats]

The metabolism of lomerizine was investigated after the oral administration of [methine-14C] or [benzyl-14C]lomerizine hydrochloride in rats. 1. Urinary, fecal and biliary excretions of the unchanged drug were less than 1% of dose, showing that lomerizine was eliminated by the extensive biotransformation after the oral administration. 2. The main metabolites were 1-(2,3,4-trimethoxybenzyl)piperazine (M7) and 2,3-dimethoxy-4-hydroxybenzylpiperazine in the urine, and 1-[bis(4-fuluorophenyl)methyl]-4-(2,3-dimethoxy-4-hydroxybenzyl)pi perazine in the feces and bile. 3. The radioactive substances in the plasma, liver and brain mainly existed as unconjugated forms, of which the intact drug showed the highest concentration. 4. The main metabolites in the plasma, and in the liver and brain were 1-[bis(4-fuluorophenyl)methyl]-4-(3,4-dimethoxy-2-hydroxybenzyl)pi perazine and bis(4-fluorophenyl)methylpiperazine (M6), respectively. 5. The plasma level of M7 and the biliary excretion of bis(4-fluorophenyl)-methanol in male rats were higher than those in female rats, suggesting the sex difference in the N-dealkylation at the 4-position of piperazine ring of the drug.

[A case of primary intracranial malignant lymphoma showing a spontaneous regression]

An eighty-year-old woman, who had been admitted with disorientation and gait disturbance, was revealed to have multiple intracranial tumors in the right temporal lobe and cerebellar vermis on CT and MRI. Following intravenous injection of dexamethasone (8 mg/day) for three days, isosorbide (90ml/day) was given in order to decrease brain edema, and the tumors increased in size rapidly in the next four months. However, most of the lesions disappeared or became markedly small without any specific therapy three months after the exacerbation of the disease. The brain tumors recurred one year thereafter, and the pathological diagnosis of primary intracranial malignant lymphoma, diffuse large B-cell type was done by autopsy examination. This patient was considered to have shown a spontaneous regression during the clinical course, and the clinicopathological descriptions of the case are presumed to present characteristic features of primary, intracranial malignant lymphoma.

Cloning and characterization of Zymomonas mobilis genes encoding extracellular levansucrase and invertase

The genes encoding the extracellular levansucrase and invertase of Zymomonas mobilis have been cloned and sequenced. The levansucrase gene, sucZE2, spans 1269 bp and encodes an M(r) 46,790 polypeptide, and the invertase gene, sucZE3, is of 1239 bp and encodes an M(r) 46,110 polypeptide. The 5'-terminal sequences of both genes corresponded to the N-terminal amino acid sequences of the secreted levansucrase and invertase, implying that the secretion of both enzymes does not involve proteolytic processing of the N-terminals. Both enzyme molecules appear to carry no typical N-terminal secretion signal. Significant homology between sucZE2 and sucZE3 was observed, but both genes showed no homology to the gene encoding an intracellular invertase coexisting in Z. mobilis. Two genes, sucZE2 and sucZE3, are possibly placed in an operon because the expression of two genes were simultaneously controlled by the regulator gene zliE, previously identified.

Inhibition of mesothelial cell growth and protein synthesis by heparin

Heparin, routinely used in peritoneal dialysis, has been found to have various effects, mainly inhibitory. Its infusion into the peritoneal cavity may adversely affect mesothelial cell growth and regeneration. Thus we wished to determine if heparin inhibits mesothelial cell growth and is does-dependent. Rat mesothelial cells were incubated for 3 days and 6 days with 200, 100, 20, 2, and 0.5 U/mL of heparin. Cellular proliferation and protein synthesis were determined by liquid scintillation counting after 24-hour pulses with 3H-thymidine and 3H-leucine. Heparin at 2 and 0.5 U/mL had no significant effect on radionuclide uptake. At 100 U/mL heparin inhibited radionuclide uptake by at least 50%. These findings indicate that heparin in small concentrations may be harmless, but at higher concentrations is inhibitory to mesothelial cell growth and proliferation.