1
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Miyashita K, Ii Y, Matsuyama H, Niwa A, Kawana Y, Shibata S, Minami N, Nishino I, Tomimoto H. Sporadic Myotonic Dystrophy Type 2 in a Japanese Patient. Intern Med 2023; 62:3027-3031. [PMID: 36792202 PMCID: PMC10641181 DOI: 10.2169/internalmedicine.0425-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 01/04/2023] [Indexed: 02/16/2023] Open
Abstract
We herein report a Japanese patient with myotonic dystrophy type 2 (DM2), which is rare in Japan. A 64-year-oldman had proximal muscle weakness and grip myotonia. Electromyography showed myotonic discharges, but dystrophia-myotonica protein kinase (DMPK) was negative for CTG repeats. A muscle biopsy revealed increased central nuclei, pyknotic nuclear clumps and muscle fiber atrophy, mainly in type 2 fibers, raising the possibility of DM2. The diagnosis was genetically confirmed by the abnormal CCTG repeat size in cellular nucleic acid-binding protein (CNBP) on repeat-primed polymerase chain reaction, which was estimated to be around 4,500 repeats by Southern blotting.
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Affiliation(s)
- Koichi Miyashita
- Department of Neurology, Mie University Graduate School of Medicine, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, Japan
| | - Atsushi Niwa
- Department of Neurology, National Mie Hospital, Japan
| | - Yosuke Kawana
- Department of Neurology, Saiseikai Matsusaka General Hospital, Japan
| | - Soshi Shibata
- Department of Neurology, Suzuka Chuo General Hospital, Japan
| | - Narihiro Minami
- Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry, Japan
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Japan
| | - Ichizo Nishino
- Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry, Japan
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Japan
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2
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Ishikawa H, Mandel-Brehm C, Shindo A, Cady MA, Mann SA, Niwa A, Miyashita K, Ii Y, Zorn KC, Taniguchi A, Maeda M, Wilson MR, DeRisi JL, Tomimoto H. Long-term MRI changes in a patient with Kelch-like protein 11-associated paraneoplastic neurological syndrome. Eur J Neurol 2021; 28:4261-4266. [PMID: 34561925 DOI: 10.1111/ene.15120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to identify the long-term radiological changes, autoantibody specificities, and clinical course in a patient with kelch-like protein 11 (KLHL11)-associated paraneoplastic neurological syndrome (PNS). METHODS Serial brain magnetic resonance images were retrospectively assessed. To test for KLHL11 autoantibodies, longitudinal cerebrospinal fluid (CSF) and serum samples were screened by Phage-display ImmunoPrecipitation and Sequencing (PhIP-Seq). Immunohistochemistry was also performed to assess for the presence of KLHL11 in the patient's seminoma tissue. RESULTS A 42-year-old man presented with progressive ataxia and sensorineural hearing loss. Metastatic seminoma was detected 11 months after the onset of the neurological symptoms. Although immunotherapy was partially effective, his cerebellar ataxia gradually worsened over the next 8 years. Brain magnetic resonance imaging revealed progressive brainstem and cerebellar atrophy with a "hot-cross-bun sign", and low-signal intensity on susceptibility-weighted imaging (SWI) in the substantia nigra, red nucleus and dentate nuclei. PhIP-Seq enriched for KLHL11-derived peptides in all samples. Immunohistochemical staining of mouse brain with the patient CSF showed co-localization with a KLHL11 commercial antibody in the medulla and dentate nucleus. Immunohistochemical analysis of seminoma tissue showed anti-KLHL11 antibody-positive particles in cytoplasm. CONCLUSIONS This study suggests that KLHL11-PNS should be included in the differential diagnosis for patients with brainstem and cerebellar atrophy and signal changes not only on T2-FLAIR but also on SWI, which might otherwise be interpreted as secondary to a neurodegenerative disease such as multiple system atrophy.
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Affiliation(s)
| | - Caleigh Mandel-Brehm
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | | | - Martha A Cady
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Sabrina A Mann
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA.,Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Atsushi Niwa
- Department of Neurology, Mie University, Mie, Japan
| | | | - Yuichiro Ii
- Department of Neurology, Mie University, Mie, Japan
| | - Kelsey C Zorn
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | | | - Masayuki Maeda
- Department of Neuroradiology, Mie University, Mie, Japan
| | - Michael R Wilson
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, California, USA
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA.,Chan Zuckerberg Biohub, San Francisco, California, USA
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3
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Nishiguchi Y, Matsuyama H, Shindo A, Matsuura K, Niwa A, Hirota Y, Fukuma T, Ito H, Kozuka Y, Tomimoto H. Cerebral Embolism Associated with Calcified Amorphous Tumor: A Review of Cerebral Infarction Cases. Intern Med 2021; 60:2315-2319. [PMID: 33612675 PMCID: PMC8355388 DOI: 10.2169/internalmedicine.6262-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Calcified amorphous tumor (CAT) is a non-neoplastic tumor composed of calcified nodules consisting of amorphous fibrous material, and it may eventually cause cerebral infarction (CI). We experienced a 67-year-old woman with CAT who had recurrent CI. After excision of the CAT, the CI did not show recurrence. A review of previous papers on CI due to CAT in Pubmed revealed that 7 of 13 studies originated in Japan and that CI can occur even with small CAT. Surgical treatment is recommended to prevent CI recurrence, especially when CAT is accompanied by mitral annular calcification or has marked mobility.
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Affiliation(s)
- Yamato Nishiguchi
- Department of Neurology, Mie University Graduate School of Medicine, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Japan
| | - Yumi Hirota
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Tomoyuki Fukuma
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Hisato Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Japan
| | - Yuji Kozuka
- Department of Pathology, Mie University Graduate School of Medicine, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Japan
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4
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Ishikawa H, Niwa A, Kato S, Ii Y, Shindo A, Matsuura K, Nishiguchi Y, Tamura A, Taniguchi A, Maeda M, Hashizume Y, Tomimoto H. Micro-MRI improves the accuracy of clinical diagnosis in cerebral small vessel disease. Brain Commun 2021; 3:fcab070. [PMID: 33997783 PMCID: PMC8111066 DOI: 10.1093/braincomms/fcab070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022] Open
Abstract
Even with postmortem pathological examination, only limited information is provided of the foci of in vivo clinical information. Cerebral small vessel disease, which is associated with ageing, dementia and stroke, highlights the difficulty in arriving at a definitive diagnosis of the lesions detected on in vivo radiological examination. We performed a radiological−pathological comparative study using ex vivo MRI to examine small cerebral lesions. Four patients with small vessel disease lesions detected on in vivo MRI were studied. Exact pathological findings of in vivo MRI-detected lesions were revealed. The ischaemic lesion after 17 days from onset showed positivity for peroxiredoxin, cluster of differentiation 204 and glial fibrillary acidic protein, indicating sterile inflammation and neuroprotective reaction. Cortical microinfarcts beneath the cortical superficial siderosis were associated with inflammation from the superficial layer in a patient with cerebral amyloid angiopathy; in this patient, a bilinear track-like appearance of the cortical superficial siderosis on the ex vivo MRI was compatible with iron deposition on the pia matter and within cortical layers II–III. An in vivo MRI-detected cerebral microbleed was revealed to be heterogeneous. An in vivo MRI-detected cerebral microbleed was revealed to be a venous angioma. Furthermore, a neuropathologically confirmed embolic cerebral microbleed was firstly detected using this method. Our results suggest that in vivo MRI-detected lobar cerebral microbleeds can be caused by non-cerebral amyloid angiopathy aetiologies, such as microembolism and venous angioma. Venous angioma and embolic microbleeds may mimic cerebral amyloid angiopathy markers on in vivo MRI. To clarify the clinical importance of these lesions, we should investigate their rate and frequency in a large cohort of healthy individuals and patients with cardiac risk factors. Thus, we provide evidence that ex vivo micro-MRI improves the clinical diagnosis of small vessel diseases.
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Affiliation(s)
- Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Shinya Kato
- Radioisotope Facilities for Medical Science, Advanced Science Research Promotion Center, Mie University, Tsu, Mie, 514-8507, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yamato Nishiguchi
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Asako Tamura
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Masayuki Maeda
- Department of Neuroradiology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yoshio Hashizume
- Department of Neuropathology, Fukushimura Hospital, Aichi 441-8124, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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5
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Matsuda K, Satoh M, Tabei KI, Ueda Y, Taniguchi A, Matsuura K, Asahi M, Ii Y, Niwa A, Tomimoto H. Impairment of intermediate somatosensory function in corticobasal syndrome. Sci Rep 2020; 10:11155. [PMID: 32636419 PMCID: PMC7340789 DOI: 10.1038/s41598-020-67991-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/15/2020] [Indexed: 11/09/2022] Open
Abstract
Corticobasal syndrome (CBS) is characterized by unilateral atrophy of the brain. New diagnostic criteria for CBS include intermediate somatosensory dysfunction. Here, we aimed to carefully examine intermediate somatosensory function to identify tests which can assess impairment in CBS patients. Using voxel-based morphometry (VBM), we also aimed to show the anatomical bases of these impairments. Subjects included 14 patients diagnosed with CBS and 14 patients with Parkinson's disease (PD). Patients were evaluated using intermediate somatosensory tests and neuropsychological assessments. VBM was used to analyze differences in gray matter volumes between CBS and PD patients. In the PD group, no tests showed a significant difference between the dominant-side onset and the non-dominant-side onset. In the CBS group, all tests showed worse scores on the affected side. For detecting intermediate somatosensory dysfunction in CBS, two tests are recommended: tactile object naming and 2-point discrimination. VBM analysis showed that the volume of the left post- and pre-central gyrus, and both sides of the supplementary motor area were significantly decreased in the CBS group compared to the PD group. Although CBS remains untreatable, early and correct diagnosis is possible by performing close examination of intermediate somatosensory function.
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Affiliation(s)
- Kana Matsuda
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan.,Department of Rehabilitation, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Ken-Ichi Tabei
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan.,Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Yukito Ueda
- Department of Rehabilitation, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaru Asahi
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
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6
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Shindo A, Ishikawa H, Ii Y, Niwa A, Tomimoto H. Clinical Features and Experimental Models of Cerebral Small Vessel Disease. Front Aging Neurosci 2020; 12:109. [PMID: 32431603 PMCID: PMC7214616 DOI: 10.3389/fnagi.2020.00109] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/30/2020] [Indexed: 12/24/2022] Open
Abstract
Cerebral small vessel disease (SVD) refers to a group of disease conditions affecting the cerebral small vessels, which include the small arteries, arterioles, capillaries, and postcapillary venules in the brain. SVD is the primary cause of vascular cognitive impairment and gait disturbances in aged people. There are several types of SVD, though arteriolosclerosis, which is mainly associated with hypertension, aging, and diabetes mellitus, and cerebral amyloid angiopathy (CAA) comprise most SVD cases. The pathology of arteriolosclerosis-induced SVD is characterized by fibrinoid necrosis and lipohyalinosis, while CAA-associated SVD is characterized by progressive deposition of amyloid beta (Aβ) protein in the cerebral vessels. Brain magnetic resonance imaging (MRI) has been used for examination of SVD lesions; typical lesions are characterized by white matter hyperintensity, lacunar infarcts, enlargement of perivascular spaces (EPVS), microbleeds, cortical superficial siderosis (cSS), and cortical microinfarcts. The microvascular changes that occur in the small vessels are difficult to identify clearly; however, these consequent image findings can represent the SVD. There are two main strategies for prevention and treatment of SVD, i.e., pharmacotherapy and lifestyle modification. In this review, we discuss clinical features of SVD, experimental models replicating SVD, and treatments to further understand the pathological and clinical features of SVD.
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Affiliation(s)
- Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie University, Tsu, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Mie University, Tsu, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie University, Tsu, Japan
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7
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Ishikawa H, Ii Y, Shindo A, Tabei KI, Umino M, Ito AO, Matsuura K, Taniguchi A, Matsuyama H, Niwa A, Ogura T, Yoshimaru K, Satoh M, Maeda M, Tomimoto H. Cortical Microinfarcts Detected by 3-Tesla Magnetic Resonance Imaging. Stroke 2020; 51:1010-1013. [DOI: 10.1161/strokeaha.119.028202] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background and Purpose—
Cortical microinfarcts (CMIs) are small ischemic lesions found in cerebral amyloid angiopathy (CAA) and embolic stroke. This study aimed to differentiate CMIs caused by CAA from those caused by microembolisms, using 3-Tesla magnetic resonance imaging.
Methods—
We retrospectively investigated 70 patients with at least 1 cortical infarct <10 mm on 3-dimensional double inversion recovery imaging. Of the 70 patients, 43 had an embolic stroke history (Emboli-G) while 27 had CAA-group. We compared the size, number, location, and distribution of CMIs between groups and designed a radiological score for differentiation based on the comparisons.
Results—
CAA-group showed significantly more lesions <5 mm, which were restricted to the cortex (
P
<0.01). Cortical lesion number was significantly higher in Emboli-G than in CAA-group (4 versus 2;
P
<0.01). Lesions in CAA-group and Emboli-G were disproportionately located in the occipital lobe (
P
<0.01) and frontal or parietal lobe (
P
=0.04), respectively. In radiological scoring, ≥3 points strongly predicted microembolism (sensitivity, 63%; specificity, 92%) or CAA (sensitivity, 63%; specificity, 91%). The areas under the receiver operating characteristic curve were 0.85 and 0.87 for microembolism and CAA, respectively.
Conclusions—
Characteristics of CMIs on 3T-magnetic resonance imaging may differentiate CMIs due to CAA from those due to microembolisms.
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Affiliation(s)
- Hidehiro Ishikawa
- From the Department of Neurology (H.I., Y.I., A.S., K.-i.T., A.O.I., K.M., A.T., H.M., A.N., H.T.), Mie University Hospital, Tsu, Japan
| | - Yuichiro Ii
- From the Department of Neurology (H.I., Y.I., A.S., K.-i.T., A.O.I., K.M., A.T., H.M., A.N., H.T.), Mie University Hospital, Tsu, Japan
| | - Akihiro Shindo
- From the Department of Neurology (H.I., Y.I., A.S., K.-i.T., A.O.I., K.M., A.T., H.M., A.N., H.T.), Mie University Hospital, Tsu, Japan
| | - Ken-ichi Tabei
- From the Department of Neurology (H.I., Y.I., A.S., K.-i.T., A.O.I., K.M., A.T., H.M., A.N., H.T.), Mie University Hospital, Tsu, Japan
- Master Program of Innovation for Design and Engineering, Advanced Institute of Industrial Technology, Tokyo Metropolitan University, Japan (K.-i.T.)
| | - Maki Umino
- Department of Radiology (M.U.), Mie University Hospital, Tsu, Japan
| | - Ai Ogawa Ito
- From the Department of Neurology (H.I., Y.I., A.S., K.-i.T., A.O.I., K.M., A.T., H.M., A.N., H.T.), Mie University Hospital, Tsu, Japan
| | - Keita Matsuura
- From the Department of Neurology (H.I., Y.I., A.S., K.-i.T., A.O.I., K.M., A.T., H.M., A.N., H.T.), Mie University Hospital, Tsu, Japan
| | - Akira Taniguchi
- From the Department of Neurology (H.I., Y.I., A.S., K.-i.T., A.O.I., K.M., A.T., H.M., A.N., H.T.), Mie University Hospital, Tsu, Japan
| | - Hirofumi Matsuyama
- From the Department of Neurology (H.I., Y.I., A.S., K.-i.T., A.O.I., K.M., A.T., H.M., A.N., H.T.), Mie University Hospital, Tsu, Japan
| | - Atsushi Niwa
- From the Department of Neurology (H.I., Y.I., A.S., K.-i.T., A.O.I., K.M., A.T., H.M., A.N., H.T.), Mie University Hospital, Tsu, Japan
| | - Toru Ogura
- Clinical Research Support Center (T.O.), Mie University Hospital, Tsu, Japan
| | - Kimiko Yoshimaru
- Department of Dementia Prevention and Therapeutics (K.Y., M.S.), Mie University Hospital, Tsu, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics (K.Y., M.S.), Mie University Hospital, Tsu, Japan
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Japan (M.M.)
| | - Hidekazu Tomimoto
- From the Department of Neurology (H.I., Y.I., A.S., K.-i.T., A.O.I., K.M., A.T., H.M., A.N., H.T.), Mie University Hospital, Tsu, Japan
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8
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Ishikawa H, Ii Y, Shindo A, Niwa A, Tomimoto H. Abstract TP213: Diagnostic Score to Differentiate the Etiology of Cortical Microinfarcts on 3-Tesla MRI. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Cortical microinfarcts (CMIs) are small ischemic lesions found in cerebral amyloid angiopathy (CAA) patients, which are also associated with embolic stroke. This study aimed to differentiate cortical microinfarcts caused by CAA from those caused by microembolism, using 3-tesla magnetic resonance imaging.
Methods:
We retrospectively investigated 119 patients with at least 1 cortical infarct <10 mm on 3D double inversion recovery imaging. Forty-three patients with an embolic stroke history were included as the emboli group (Emboli-G) and 27 patients with CAA were included as the CAA group (CAA-G), based on the modified Boston criteria. We compared the size, number, location, and distribution of CMIs between groups to assess CMI etiology. Using this information, we designed a radiological diagnostic score, which incorporated data on the location, size, distribution, and numbers of CMIs.
Results:
CAA-G patients showed significantly more lesions <5 mm, which were restricted to the cortex (p<0.01). Cortical lesion number was significantly higher in Emboli-G than in CAA-G patients (4 vs 2; p<0.01). The diameter of cortical lesions was significantly larger in Emboli-G than in CAA-G patients (3.8 mm vs 3.0 mm; p<0.01). Lesions in CAA-G and Emboli-G patients were disproportionately located in the occipital lobe (p<0.01) and frontal or parietal lobe (p=0.04), respectively. In diagnostic scoring, a score of ≥3 points strongly predicted microembolism (sensitivity, 63%; specificity, 92%) or CAA (sensitivity, 63%; specificity, 91%). The area under the curve was 0.85 and 0.87 for microembolism and CAA, respectively.
Conclusions:
Our radiological diagnostic score may be a powerful tool for differentiating the etiology of CMIs.
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Ishikawa H, Shindo A, Ii Y, Kishida D, Niwa A, Nishiguchi Y, Matsuura K, Kato N, Mizutani A, Tachibana K, Hirata Y, Matsuyama H, Ogawa-Ito A, Taniguchi A, Tomimoto H. MEFV gene mutations in neuro-Behçet's disease and neuro-Sweet disease. Ann Clin Transl Neurol 2019; 6:2595-2600. [PMID: 31682063 PMCID: PMC6917328 DOI: 10.1002/acn3.50937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/28/2019] [Accepted: 10/14/2019] [Indexed: 01/06/2023] Open
Abstract
Mediterranean fever (MEFV) gene mutations are associated with familial Mediterranean fever (FMF). Recent studies have suggested that MEFV gene mutations may act as disease modifiers in neuro‐Behçet's (NBD) disease and neuro‐Sweet disease (NSD). We investigated MEFV genes and clinical features in 17 patients with NBD or NSD. MEFV gene mutations were frequently observed (70.6%). Headaches and exertional leg pain were associated with MEFV gene mutations (P < 0.05). Moreover, higher frequency of white matter lesions without sites predilection (P < 0.05) and non‐parenchymal lesions (P < 0.05) were also observed. MEFV gene mutations may be associated with particular findings and lesion sites.
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Affiliation(s)
- Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Nagano, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yamato Nishiguchi
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Natsuko Kato
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akane Mizutani
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kei Tachibana
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yoshinori Hirata
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hirofumi Matsuyama
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Ai Ogawa-Ito
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
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10
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Matsuda K, Satoh M, Tabei KI, Ueda Y, Itoh A, Ishikawa H, Matsuo K, Shindo A, Asahi M, Niwa A, Matsuura K, Tomimoto H. Subregional heterogeneity of somatosensory dysfunction in the insula. J Neurol Neurosurg Psychiatry 2019; 90:957-958. [PMID: 30455405 DOI: 10.1136/jnnp-2018-319174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/03/2018] [Accepted: 11/01/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Kana Matsuda
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan .,Department of Rehabilitation, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ken-Ichi Tabei
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan.,Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yukito Ueda
- Department of Rehabilitation, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ai Itoh
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ko Matsuo
- Department of Neurology, Japanese Red Cross Ise Hospital, Ise, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaru Asahi
- Department of Neurology, Yokkaichi Hazu Medical Center, Yokkaichi, Japan
| | - Atsushi Niwa
- Department of Neurology, National Mie Hospital, Tsu, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan.,Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
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11
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Shimada T, Shindo A, Matsuyama H, Yata K, Niwa A, Sasaki R, Ayaki T, Maki T, Wakita H, Tomimoto H. Chronic cerebral hypoperfusion upregulates leptin receptor expression in astrocytes and tau phosphorylation in tau transgenic mice. Neurosci Lett 2019; 704:133-140. [DOI: 10.1016/j.neulet.2019.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 02/18/2019] [Accepted: 04/03/2019] [Indexed: 12/27/2022]
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12
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Ii Y, Maeda M, Ishikawa H, Ito A, Matsuo K, Umino M, Shindo A, Kida H, Satoh M, Niwa A, Taniguchi A, Tomimoto H. Cortical microinfarcts in patients with multiple lobar microbleeds on 3 T MRI. J Neurol 2019; 266:1887-1896. [DOI: 10.1007/s00415-019-09350-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/13/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
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13
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Matsuyama H, Matsuura K, Ishikawa H, Hirata Y, Kato N, Niwa A, Narita Y, Tomimoto H. Proposition of zinc supplementation during levodopa-carbidopa intestinal gel treatment. Brain Behav 2018; 8:e01143. [PMID: 30358126 PMCID: PMC6305909 DOI: 10.1002/brb3.1143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Levodopa-carbidopa intestinal gel (LCIG) infusion is a useful therapy for the wearing-off phenomenon of advanced Parkinson's disease (PD) patients. Recently, we found three PD patients that may have had a zinc deficiency after the LCIG infusion, possibly due to the zinc-chelating action of levodopa. This study aims to evaluate changes in serum zinc levels in three patients that received LCIG treatment and to determine possible remedies for zinc deficiency during treatment. MATERIALS AND METHODS We performed a prospective blood analysis of serum zinc levels before, when possible, and after LCIG treatment in our three PD patients. RESULTS The serum zinc levels of the first patient before treatment and 4 months after beginning LCIG treatment were 69 and 58 μg/dl, respectively. For the second patient, serum zinc levels before treatment and two months after starting LCIG treatment were 87 and 46 μg/dl, respectively. The baseline serum zinc level for the third patient was not examined, but was 48 μg/dl 5 months after starting the LCIG infusion. CONCLUSIONS Levodopa-carbidopa intestinal gel infusion might have caused a zinc deficiency through levodopa zinc chelation. Zinc deficiency with LCIG infusion has not yet been reported, though preventing zinc deficiency may be an important factor in future LCIG treatment strategies.
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Affiliation(s)
- Hirofumi Matsuyama
- Department of NeurologyMie University Graduate School of MedicineTsuJapan
| | - Keita Matsuura
- Department of NeurologyMie University Graduate School of MedicineTsuJapan
| | - Hidehiro Ishikawa
- Department of NeurologyMie University Graduate School of MedicineTsuJapan
| | - Yoshinori Hirata
- Department of NeurologyMie University Graduate School of MedicineTsuJapan
| | - Natsuko Kato
- Department of NeurologyMie University Graduate School of MedicineTsuJapan
| | - Atsushi Niwa
- Department of NeurologyMie University Graduate School of MedicineTsuJapan
| | - Yugo Narita
- Department of NeurologyMie University Graduate School of MedicineTsuJapan
| | - Hidekazu Tomimoto
- Department of NeurologyMie University Graduate School of MedicineTsuJapan
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14
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Ishikawa H, Shindo A, Ii Y, Niwa A, Matsuura K, Kishida D, Tomimoto H. Mediterranean fever gene mutations in patients with possible neuro-Sweet disease: a case series. J Neurol Neurosurg Psychiatry 2018; 89:1119-1121. [PMID: 29175894 DOI: 10.1136/jnnp-2017-316667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/01/2017] [Accepted: 11/04/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Nagano, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
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15
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Matsuo K, Shindo A, Niwa A, Tabei KI, Akatsu H, Hashizume Y, Akiyama H, Ayaki T, Maki T, Sawamoto N, Takahashi R, Oikawa S, Tomimoto H. Complement Activation in Capillary Cerebral Amyloid Angiopathy. Dement Geriatr Cogn Disord 2018; 44:343-353. [PMID: 29421784 DOI: 10.1159/000486091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/30/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is classified as type 1 with capillary amyloid β (Aβ) or type 2 without capillary Aβ. While it is known that CAA activates complement, an inflammatory mediator, there is no information on the relationship between capillary Aβ and complement activation. METHODS We evaluated 34 autopsy brains, including 22 with CAA and 12 with other neurodegenerative diseases. We assessed the vascular density of CAA by analyzing the expression of complement (C1q, C3d, C6, C5b-9), macrophage scavenger receptor (MSR), and apolipoprotein E (ApoE). RESULTS Capillary immunostaining for C1q, C3d, MSR, and ApoE was identified almost exclusively in CAA-type1 brains. There was intense expression of C1q, C3d, MSR, and ApoE, as well as weaker expression of C5b-9 and C6 in the arteries/ arterioles of both CAA subtypes, but not in control brains. C5b-9 and C6 were preferentially expressed in arteries/arterioles with subcortical hemorrhage or cortical superficial siderosis. Triple immunofluorescence revealed that C1q, C3d, and ApoE were colocalized with Aβ in CAA brain capillaries. CONCLUSION Complement, MSR, and ApoE were only coexpressed in the presence of Aβ accumulation in capillaries, suggesting a role for complement activation in the propagation of Aβ. Additionally, C5b-9 expression may be associated with hemorrhagic brain injury in CAA.
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Affiliation(s)
- Ko Matsuo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ken-Ichi Tabei
- Department of Dementia Prevention and Therapeutics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroyasu Akatsu
- Choju Medical Institute, Fukushimura Hospital, Toyohashi, Japan
| | | | - Haruhiko Akiyama
- Department of Clinical Research, Yokohama Brain and Spine Center, Yokohama, Japan
| | - Takashi Ayaki
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takakuni Maki
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobukatsu Sawamoto
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinji Oikawa
- Department of Environmental and Molecular Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
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16
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Ishikawa H, Ii Y, Niwa A, Shindo A, Ito A, Matsuura K, Sasaki R, Uno K, Maeda M, Tomimoto H. Comparison of Premortem Magnetic Resonance Imaging and Postmortem Autopsy Findings of a Cortical Microinfarct. J Stroke Cerebrovasc Dis 2018; 27:2623-2626. [PMID: 29970322 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 10/28/2022] Open
Abstract
An 85-year-old woman diagnosed with amyotrophic lateral sclerosis died of pneumonia and was autopsied. Magnetic resonance imaging (MRI) performed 16 days before death revealed an intracortical high-intensity lesion in her right temporal cortex on three-dimensional (3D)-double inversion recovery (DIR) and 3D-fluid-attenuated inversion recovery (FLAIR) images. Histopathological examination indicated a cortical microinfarct (CMI) juxtaposed to cerebral amyloid angiopathy. Recently, in vivo detection of CMIs using 3D-DIR and 3D-FLAIR on 3-tesla MRI has been reported, and postmortem MRI study confirmed the presence of CMIs. This is the first case study to compare CMI findings detected upon premortem MRI to the CMI itself discovered upon postmortem neuropathological examination.
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Affiliation(s)
- Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Ai Ito
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Ryogen Sasaki
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan; Department of Neurology, National Mie Hospital, Tsu, Mie, Japan
| | - Kenichiro Uno
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan; Department of Neurology, Matsusaka Central General Hospital, Matsusaka, Mie, Japan
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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17
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Kanazawa N, Honda-Ozaki F, Terashima M, Niwa A, Yanagimachi M, Furukawa F, Nakahata T, Saito M. 983 Pluripotent stem cell model of Nakajo-Nishimura syndrome untangles proinflammatory pathways mediated by oxidative stress. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Niwa A, Ii Y, Shindo A, Matsuo K, Ishikawa H, Taniguchi A, Takase S, Maeda M, Sakuma H, Akatsu H, Hashizume Y, Tomimoto H. Comparative Analysis of Cortical Microinfarcts and Microbleeds using 3.0-Tesla Postmortem Magnetic Resonance Images and Histopathology. J Alzheimers Dis 2018; 59:951-959. [PMID: 28697558 PMCID: PMC5545920 DOI: 10.3233/jad-161242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Microvascular lesions including cortical microinfarctions (CMIs) and cerebral lobar microbleeds (CMBs) are usually caused by cerebral amyloid angiopathy (CAA) in the elderly and are correlated with cognitive decline. However, their radiological-histopathological coincidence has not been revealed systematically with widely used 3-Tesla (3T) magnetic resonance imaging (MRI). The purpose of the present study is to delineate the histopathological background corresponding to MR images of these lesions. We examined formalin-fixed 10-mm thick coronal brain blocks from 10 CAA patients (five were also diagnosed with Alzheimer's disease, three with dementia with Lewy bodies, and two with CAA only) with dementia and six non CAA patients with neurodegenerative disease. Using 3T MRI, both 3D-fluid attenuated inversion recovery (FLAIR) and 3D-double inversion recovery (DIR) were examined to identify CMIs, and T2* and susceptibility-weighted images (SWI) were examined to identify CMBs. These blocks were subsequently examined histologically and immunohistochemically. In CAA patients, 48 CMIs and 6 lobar CMBs were invariably observed in close proximity to degenerated Aβ-positive blood vessels. Moreover, 16 CMIs (33%) of 48 were detected with postmortem MRI, but none were seen when the lesion size was smaller than 1 mm. In contrast, only 1 undeniable CMI was founded with MRI and histopathology in 6 non CAA patients. Small, cortical high-intensity lesions seen on 3D-FLAIR and 3D-DIR images likely represent CMIs, and low-intensity lesions in T2* and SWI correspond to CMBs with in vivo MRI. Furthermore, a close association between amyloid-laden vessels and these microvascular lesions indicated the contribution of CAA to their pathogenesis.
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Affiliation(s)
- Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Ko Matsuo
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hidehiro Ishikawa
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
| | - Shinichi Takase
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Masayuki Maeda
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Mie, Japan
| | - Hiroyasu Akatsu
- Department of Neuropathology, Fukushimura Hospital, Aichi, Japan
| | - Yoshio Hashizume
- Department of Neuropathology, Fukushimura Hospital, Aichi, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Mie, Japan
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19
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Niwa A, Ii Y, Shindo A, Matsuo K, Ishikawa H, Tanigushi A, Takase S, Maeda M, Akatsu Y, Hashizume Y, Tomimoto H. Comparative analysis of cortical microinfarcts and microbleeds using 3.0-tesla postmortem magnetic resonance images and histopathology. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Matsuo K, Shindo A, Niwa A, Akiyama H, Akatsu H, Hashizume Y, Takahashi R, Tomimoto H. Complement in human capillary cerebral amyloid angiopathy. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Ii Y, Maeda M, Ito A, Umino M, Kida H, Satoh M, Niwa A, Taniguchi A, Tomimoto H. Underlying etiology of cortical microinfarcts on 3T MRI in patients with cognitive impairment. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Ishikawa H, Shindo A, Ii Y, Niwa A, Matsuura K, Kishida D, Hidekazu T. Mediterranean fever gene mutations in patients with central nervous inflammation diagnosed with possible neuro-sweet disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Toya C, Muramoto H, Iwai S, Higuchi K, Tsunamoto H, Matsumoto S, Ozawa T, Araki K, Ohnishi T, Kobayashi I, Ohnishi Y, Umezawa S, Niwa A, Hirao K. 1680The assessment of left atrial appendage flow by computed tomography using serial snapshots method. Europace 2017. [DOI: 10.1093/ehjci/eux160.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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24
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Higuchi K, Toya C, Iwai S, Muramoto H, Tsunamoto H, Matsumoto S, Ozawa T, Onishi T, Kobayashi I, Onishi Y, Umezawa S, Niwa A, Yokoyama Y, Hirao K. P871Changes in continuous wavelet transform of left atrium before and after pulmonary vein isolation in patients with persistent atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux151.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Iwai S, Higuchi K, Toya C, Muramoto H, Tsunamoto H, Matsumoto S, Ozawa T, Araki K, Onishi T, Kobayashi I, Onishi Y, Umezawa S, Niwa A, Hirao K. P1401Distributions and correlation of left atrial low voltage zone detected by high density multi-electrode catheter during atrial fibrillation and sinus rhythm. Europace 2017. [DOI: 10.1093/ehjci/eux158.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Iwai S, Higuchi K, Toya C, Muramoto H, Tsunamoto H, Matsumoto S, Ozawa T, Araki K, Onishi T, Kobayashi I, Onishi Y, Umezawa S, Niwa A, Hirao K. P934The electroanatomical characteristics of the patients who need epicardial coronary sinus approach for complete conduction block along mitral isthmus. Europace 2017. [DOI: 10.1093/ehjci/eux151.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Toya C, Higuchi K, Iwai S, Hirotaka M, Tsunamoto H, Matsumoto S, Ozawa T, Araki K, Ohnishi T, Kobayashi I, Ohnishi Y, Umezawa S, Niwa A, Yokoyama Y, Hirao K. P341Comparison of locations between continuous wavelet transform analysis and complex fractionated atrial electrogram in patients with persistent atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux141.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Ishikawa H, Ii Y, Niwa A, Matsuura K, Maeda M, Tomimoto H. A case of 55-year-old man with first-ever generalized seizure diagnosed with Sturge-Weber syndrome type III by characteristic MRI findings. Rinsho Shinkeigaku 2017; 57:214-219. [PMID: 28450688 DOI: 10.5692/clinicalneurol.cn-001006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 55-year-old man with no mental retardation had presented a history of frequent transient clumsiness of his right upper and lower extremities for about 20 years. He was admitted to a general hospital with weakness of right side of the body, and first-ever generalized seizure attack occurred the next day. Brain CT showed calcification in the left cerebral cortices. So he was referred to our hospital. On neurological examination, he had mild clumsiness of his right upper limb and right pyramidal tract sign. He had neither facial port-wine stain nor glaucoma. The blood test and cerebrospinal fluid analysis were unremarkable. Electroencephalogram showed slowing and reduction of activity at the left frontal and parietal areas with no epileptic activities. Brain CT showed "tram-track calcification" and lobar atrophy in the left fronto-parietal cortices. Susceptibility weighted imaging (SWI) on MRI revealed enlarged transmedullary veins in the left periventricular white matter and low intensity lesions along the cortical gyri. Post gadolinium fluid-attenuated inversion recovery imaging (FLAIR-Gd) showed leptomeningeal enhancement in the left fronto-parietal lobes more extensively than those by post gadolinium T1-weighted image. Brain perfusion single photon emission computed tomography with a technetium-99m-ethyl cysteinate dimer (99mTc-ECD SPECT) revealed hypoperfusion in the fronto-parietal lobes. These clinical and neuroimaging findings were compatible with type III Sturge-Weber syndrome (SWS). His condition was improved after treatment with oral levetiracetam (1,000 mg daily). Although adult-onset type III SWS is very rare, it is important to perform SWI and post-contrast FLAIR for assessing leptomeningeal angioma in patients with seizure with focal cortical calcification even if they have no facial nevus.
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Affiliation(s)
| | - Yuichiro Ii
- Department of Neurology, Mie University Graduate School of Medicine
| | - Atsushi Niwa
- Department of Neurology, Mie University Graduate School of Medicine
| | - Keita Matsuura
- Department of Neurology, Mie University Graduate School of Medicine
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine
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Ito M, Murakami M, Saito M, Niwa A, Osawa M, Nakahata T, Nishimoto N. AB0100 Monocytes Differentiated from IPS Cells Derived from Rheumatoid Arthritis Patients Express More M-Scf-Receptor Together with Rank Than Those from Healthy Donors Resulting in the Accelerated Osteoclastgenesis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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30
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Nishimoto N, Murakami M, Ito M, Saito M, Niwa A, Nakahata T. AB0049 Appearance of CD14+CD15+ Poplulation During the Differentiation from RA-IPS Cells into Monocytes. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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31
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Tamura A, Niwa A, Ii Y, Sasaki R, Tomimoto H, Saitsu H. [A case of hypomyelinating leukodystrophy with new homozygous mutation in POLR3A]. Rinsho Shinkeigaku 2014; 53:624-9. [PMID: 23965854 DOI: 10.5692/clinicalneurol.53.624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a 34-year-old man with hypomyelination, hypogonadotropic hypogonadism, ataxia, and myopia without hypodontia. He was born to non-consanguineous parents, and had an elder brother who showed a similar phenotype. Laboratory studies demonstrated low level of LH, FSH and testosterone. MRI showed hypomyelination, atrophy of the cerebellum and the hypoplastic corpus callosum. Homozygous missensze mutation c.2350G>A (p.Gly784Ser) was found in POLR3A,which codes for the largest subunit of RNA polymerase III. Since PolIII-related leukodystrophies shows various combination of neurologic and non-neurologic features, additional reports will help to confirm the mechanism of this disease.
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Affiliation(s)
- Asako Tamura
- Department of Neurology, Mie University Graduate School of Medicine, Japan
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Niwa A, Okamoto Y, Kondo T, Nabatame H, Takahashi R, Tomimoto H. Perivasculitic panencephalitis with relapsing polychondritis: an autopsy case report and review of previous cases. Intern Med 2014; 53:1191-5. [PMID: 24881747 DOI: 10.2169/internalmedicine.53.1381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report an autopsy case of relapsing polychondritis encephalitis coexisting with a Lewy body pathology and also review previous autopsy cases. A 59-year-old man exhibited a tremor of the right hand, small-steppage gait and bradykinesia. Five years later, he presented with relapsing auricular chondritis and scleritis and subsequently showed exacerbation of extrapyramidal symptoms. A histological examination revealed perivascular lymphocytic cuffing and infiltration in the small vessels, as well as loss of nerve cells and gliosis in the basal ganglia, insular gyrus and medial temporal lobe. The present case was characterized by perivasculitic panencephalitis and the coexistence of a Lewy body pathology, which may have augmented the patient's parkinsonism.
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Affiliation(s)
- Atsushi Niwa
- Department of Neurology, Mie University School of Medicine, Japan
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Niwa A, Matsuo K, Shindo A, Yata K, Shiraishi T, Tomimoto H. Clinical and neuropathological findings in a patient with familial Alzheimer disease showing a mutation in thePSEN1gene. Neuropathology 2012; 33:199-203. [DOI: 10.1111/j.1440-1789.2012.01340.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Szeimies RM, Torezan L, Niwa A, Valente N, Unger P, Kohl E, Schreml S, Babilas P, Karrer S, Festa-Neto C. Clinical, histopathological and immunohistochemical assessment of human skin field cancerization before and after photodynamic therapy. Br J Dermatol 2012; 167:150-9. [PMID: 22329784 DOI: 10.1111/j.1365-2133.2012.10887.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The field cancerization concept in photodamaged patients suggests that the entire sun-exposed surface of the skin has an increased risk for the development of (pre)-malignant lesions, mainly epithelial tumours. Topical photodynamic therapy (PDT) is a noninvasive therapeutic method for multiple actinic keratosis (AK) with excellent outcome. OBJECTIVES To evaluate the clinical, histological and immunohistochemical changes in human skin with field cancerization after multiple sessions of PDT with methyl-aminolaevulinate (MAL). METHODS Twenty-six patients with photodamaged skin and multiple AK on the face received three consecutive sessions of MAL-PDT with red light (37 J cm(-2)), 1 month apart. Biopsies before and 3 months after the last treatment session were taken from normal-appearing skin on the field-cancerized area. Immunohistochemical stainings were performed for TP-53, procollagen-I, metalloproteinase-1 (MMP-1) and tenascin-C (Tn-C). RESULTS All 26 patients completed the study. The global score for photodamage improved considerably in all patients (P < 0·001). The AK clearance rate was 89·5% at the end of the study. Two treatment sessions were as effective as three MAL-PDT sessions. A significant decrease in atypia grade and extent of keratinocyte atypia was observed histologically (P < 0·001). Also, a significant increase in collagen deposition (P = 0·001) and improvement of solar elastosis (P = 0·002) were noticed after PDT. However, immunohistochemistry showed only a trend for decreased TP-53 expression (not significant), increased procollagen-I and MMP-1 expressions (not significant) and an increased expression of Tn-C (P = 0·024). CONCLUSIONS Clinical and histological improvement in field cancerization after multiple sessions of MAL-PDT is proven. The decrease in severity and extent of keratinocyte atypia associated with a decreased expression of TP-53 suggest a reduced carcinogenic potential of the sun-damaged area. The significant increase of new collagen deposition and the reduction of solar elastosis explain the clinical improvement of photodamaged skin.
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Affiliation(s)
- R M Szeimies
- Department of Dermatology, Regensburg University Hospital, Regensburg, Germany.
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Markova T, Aragane Y, Niwa A, Tabuchi M, Orita M, Ooshima K, Higashino H. Effect of Theophylline and Cyclic AMP Analogue 8-Br-cAMP on Dermatophagoides Farinae induced IL-5 mRNA of Peripheral Blood Mononuclear Cells. J of Medical Sciences 2010. [DOI: 10.3923/jms.2010.59.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yamagata S, Tomita K, Sato R, Niwa A, Higashino H, Tohda Y. Interleukin-18-deficient mice exhibit diminished chronic inflammation and airway remodelling in ovalbumin-induced asthma model. Clin Exp Immunol 2008; 154:295-304. [PMID: 18826499 DOI: 10.1111/j.1365-2249.2008.03772.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Interleukin (IL)-18, which is produced by activated monocytes/macrophages and airway epithelial cells, is suggested to contribute to the pathophysiology of asthma by modulating airway inflammation. However, the involvement of IL-18 on modulating chronic airway inflammation and airway remodelling, which are characterized in a refractory asthma model exposed to long-term antigen, has not been investigated sufficiently. We examined the role of IL-18 in chronic airway inflammation and airway remodelling by long-term antigen exposure. IL-18-deficient and C57BL/6-wild-type mice were sensitized by ovalbumin (OVA) and were then exposed to aerosolized OVA twice a week for 12 weeks. We assessed airway inflammation by assessing the infiltration of cells into the airspace and lung tissues, and airway remodelling by airway mucus expression, peribronchial fibrosis and smooth muscle thickness. In IL-18-deficient mice, when exposed to OVA, the total cells and neutrophils of the bronchoalveolar lavage fluid (BALF) were diminished, as were the number of infiltrated cells in the lung tissues. IL-18-deficient mice exposed to OVA after 12 weeks showed significantly decreased levels of interferon (IFN)-gamma, IL-13 and transforming growth factor (TGF)-beta1 in the BALF. The airway hyperresponsiveness to acetyl-beta-methacholine chloride was inhibited in IL-18-deficient mice in comparison with wild-type mice. In addition, IL-18-deficient mice exposed to OVA had fewer significant features of airway remodelling. These findings suggest that IL-18 may enhance chronic airway inflammation and airway remodelling through the production of IFN-gamma, IL-13 and TGF-beta1 in the OVA-induced asthma mouse model.
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Affiliation(s)
- S Yamagata
- Department of Respiratory Medicine, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
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Abstract
We report severe brain calcification in a case of LEOPARD syndrome that has not been reported in the literature. A 53-year-old Japanese man presented with generalized lentigines, arrhythmia, gonadal hypoplasia, endocrine abnormality, mental retardation and skeletal abnormalities, and was consequently diagnosed as LEOPARD syndrome. Brain computed tomography demonstrated surprisingly dense and symmetric calcifications in the cerebellar dentate nuclei, cerebral basal ganglia, thalamus, and cerebral white matter. It may be an incidental idiopathic calcification. Alternatively it may be a rare clinical manifestation of LEOPARD syndrome.
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Affiliation(s)
- Atsushi Niwa
- Department of Neurology, Mie University School of Medicine, Tsu.
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Yamauchi Y, Sekiguchi Y, Sasaki T, Higuchi K, Kusa S, Ohnishi K, Miyamaoto T, Obayashi T, Niwa A, Aonuma K. 373 Electrocardiographic characteristics of repetitive monomorphic right ventricular tachycardia originating near the HIS-bundle. Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.78-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Y. Yamauchi
- Yokosuka Kyosai General Hospital, Cardiovascular Center, Yokosuka Koragama, Japan
| | - Y. Sekiguchi
- Musashino Red Cross Hospital, Cardiology, Musashino, Japan
| | - T. Sasaki
- Musashino Red Cross Hospital, Cardiology, Musashino, Japan
| | - K. Higuchi
- Musashino Red Cross Hospital, Cardiology, Musashino, Japan
| | - S. Kusa
- Musashino Red Cross Hospital, Cardiology, Musashino, Japan
| | - K. Ohnishi
- Musashino Red Cross Hospital, Cardiology, Musashino, Japan
| | - T. Miyamaoto
- Musashino Red Cross Hospital, Cardiology, Musashino, Japan
| | - T. Obayashi
- Musashino Red Cross Hospital, Cardiology, Musashino, Japan
| | - A. Niwa
- Musashino Red Cross Hospital, Cardiology, Musashino, Japan
| | - K. Aonuma
- Tsukuba University, Department of Cardiology, Ibaragi, Japan
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Konno R, Niwa A. Library screening for D-amino-acid oxidase gene: application of real-time PCR. Amino Acids 2004; 27:221-3. [PMID: 15365908 DOI: 10.1007/s00726-004-0120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Accepted: 08/03/2004] [Indexed: 11/25/2022]
Abstract
Quantitative real-time PCR shows the quantity in addition to the presence of the target sequence. This property seemed very useful for library screening. Then, real-time PCR was employed to screen for lambda phages carrying D-amino-acid oxidase gene from mouse genomic library. Using stepwise dilution screening combined with real-time PCR, positive phages were isolated in a short time.
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Affiliation(s)
- R Konno
- Department of Microbiology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan.
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Konagai H, Nitta J, Niwa A, Satoh Y, Nogami A, Aonuma K, Lesaka Y, Hiroe M, Marumo F. Clinical characteristics of rapid atrial fibrillation preceding ventricular tachycardia. Jpn Circ J 2001; 65:1022-8. [PMID: 11767992 DOI: 10.1253/jcj.65.1022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Spontaneous degeneration of rapid atrial fibrillation (AF) to ventricular fibrillation has been documented in patients with hypertrophic cardiomyopathy (HCM) and Wolff-Parkinson-White (WPW) syndrome. However, the importance of rap
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Affiliation(s)
- H Konagai
- Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan
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42
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Sorimachi K, Itoh T, Kawarabayasi Y, Okayasu T, Akimoto K, Niwa A. Conservation of the basic pattern of cellular amino acid composition of archaeobacteria during biological evolution and the putative amino acid composition of primitive life forms. Amino Acids 2001; 21:393-9. [PMID: 11858698 DOI: 10.1007/s007260170004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Previous studies showed that the cellular amino acid composition obtained by amino acid analysis of whole cells, differs such as eubacteria, protozoa, fungi and mammalian cells. These results suggest that the difference in the cellular amino acid composition reflects biological changes as the result of evolution. However, the basic pattern of cellular amino acid composition was relatively constant in all organisms examined. In the present study, we examined archaeobacteria, because they are considered important in understanding the relationship between biological evolution and cellular amino acid composition. The cellular amino acid compositions of Archaeoglobus fulgidus, Pyrococcus horikoshii, Methanobacterium thermoautotrophicum and Methanococcus jannaschii differed slightly from each other, but were similar to those determined from codon usage data, based on the complete genomes. Thus, the cellular amino acid composition reflects biological evolution. We suggest that primitive forms of life appearing on earth at the end of prebiotic evolution had a similar-cellular amino acid composition.
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Affiliation(s)
- K Sorimachi
- Department of Microbiology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan.
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Ikegami A, Niwa A. A study of nurse scheduling in Japan. J Hum Ergol (Tokyo) 2001; 30:71-6. [PMID: 14564861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Scheduling nurses to staff shifts is a major problem in hospitals. The necessity of maintaining a certain level of service and skill in the makeup of every shift, while balancing the workload among the nurses involved, is incredibly difficult. It is often impossible to develop a schedule which satisfies all the requirements despite the time and resources spent in the effort. This paper summarizes all our published research on nurse scheduling to date. The difficulties realized by our two investigations in Japan are shown first, together with a resulting scheduling problem. The nurse scheduling model based on the results is then described. In this model, all constraints are divided into two essentially different types; that which maintains a certain level of skill for each shift ('shift constraints') and that which concerns the workload for each nurse ('nurse constraints'). By classifying the constraints in this manner, we can determine what is affected by a specific constraint when the constraint is not satisfied. We developed efficient algorithms while taking advantage of the structure of this model. Finally, it is shown that our algorithm can solve this problem for a 2-shift system efficiently.
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Miyamoto T, Araki T, Hiroe M, Marumo F, Niwa A, Yokoyama K. Standalone cutting balloon angioplasty for the treatment of stent-related restenosis: acute results and 3- to 6-month angiographic recurrent restenosis rates. Catheter Cardiovasc Interv 2001; 54:301-8. [PMID: 11747153 DOI: 10.1002/ccd.1288] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite excellent acute reperfusion results, 20%-30% of patients who undergo coronary stent implantation will develop angiographic restenosis and may require same additional treatments. Cutting Balloon angioplasty (CBA) causes less histological damage outside of the incised area than a regular balloon. However, regular plain old balloon angioplasty is sometimes required before CBA, as is adjunctive stenting and adjunctive angioplasty. These adjunctive strategies may negate the advantages of CBA. There is little data available on CBA as a standalone therapy for stent-related restenosis (SRS). The aim of this study was to evaluate the acute and 3- to 6-month angiographic recurrent restenosis rates following standalone CBA in a patient population treated for SRS and in whom optimal acute results were obtained. In this study, 40 patients with SRS (54 lesions) underwent standalone CBA with optimal acute results. For all lesions, coronary angiography was conducted before and after a standalone CBA procedure for SRS and systematically during 3-6 months to assess recurrent angiographic restenosis rates in the study population. In the study lesions, SRS was either diffuse disease (> 15 mm; 52%) or focal type (48%). Cutting Balloon diameter was 3.20 +/- 0.44 mm and maximal inflation pressure 8.7 +/- 1.2 atm. Ratio of Cutting Balloon diameter to restenotic stent diameter was 0.996 +/- 0.487. Multiple inflations (6 +/- 3 times) were performed. Number of used Cutting Balloon was 1.02 +/- 0.14. Complications were as follows; one non-Q-wave MI (1.9%); 0 death (0%), and 17 repeat target lesion revascularizations (TLRs; 32%). Follow-up coronary angiography (CAG) was not attained for one patient. The angiographic recurrent restenosis rate was 34%, with a higher rate observed when the SRS was diffuse type, 50% vs. 16% for focal-type SRS (P < 0.01). The recurrent restenosis rate for smaller vessels (vessel diameter < or = 3.0 mm) was the same as for larger ones. At follow-up CAG, diffuse-type recurrent restenosis (56%) presented nearly as frequently as that presenting in the original SRS lesions (52%). But four diffuse-type SRS (29%) changed into focal-type recurrent stenosis. In this study, standalone CBA for SRS with optimal acute results was associated with an angiographic restenosis rate of 34%. Diffuse-type disease had a higher recurrent restenosis rate. When CBA achieves acute optimal results, adjunctive stenting or adjunctive PTCA are not always necessary, particularly when the SRS is focal. As a result of CBA, some diffuse-type SRS may change into focal-type recurrent stenosis by the time of the next intervention.
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Affiliation(s)
- T Miyamoto
- Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan.
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Miyamoto T, Niwa A, Sinoda T. State of percutaneous transluminal coronary artery angioplasty and effectiveness of low-density lipoprotein apheresis. Ther Apher 2001; 5:226-31. [PMID: 11724505 DOI: 10.1046/j.1526-0968.2001.00339.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have recognized percutaneous transluminal coronary artery angioplasty (PTCA) as an important procedure for achieving myocardial revascularization. PTCA has been performed for stable and unstable angina, acute myocardial infarction, and silent myocardial ischemia. Among many new devices, the coronary stent is the most important advancement in PTCA. Frequent stent use is due to the introduction of antiplatelet therapy to prevent stent thrombosis. One serious problem is that PTCA, even with stent use, often causes chronic restenosis. This problem has not been solved, however, despite various strategies. Aggressive lipid-lowering therapy is one of the most important therapies for coronary heart disease. The findings in aggressive lipid-lowering therapy show us its importance. We report that low-density lipoprotein (LDL) apheresis, when performed immediately before and after PTCA, can prevent restenosis of coronary artery lesions. Lipid-lowering therapy should be applied more aggressively with medicine and/or with LDL apheresis for patients who have undergone PTCA.
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Affiliation(s)
- T Miyamoto
- Department of Cardiology, Musashino Red Cross Hospital, Musashino City, Tokyo, Japan.
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46
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Sorimachi K, Ikehara Y, Maezato G, Okubo A, Yamazaki S, Akimoto K, Niwa A. Inhibition by Agaricus blazei Murill fractions of cytopathic effect induced by western equine encephalitis (WEE) virus on VERO cells in vitro. Biosci Biotechnol Biochem 2001; 65:1645-7. [PMID: 11515550 DOI: 10.1271/bbb.65.1645] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anti-viral activities of Agaricus blazei Murill were investigated. The water extracts of the cultured mycelia and fruiting bodies were fractionated with different concentrations of ethanol. To several viruses which have cytopathic effects (CPE) on VERO cells, inhibition of these effects by the ethanol fractions was tested. Strong inhibition of CPE induced by western equine encephalitis (WEE) virus was observed in the mycelial fractions but not those of fruiting bodies.
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Affiliation(s)
- K Sorimachi
- Department of Microbiology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
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47
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Morikawa A, Hamase K, Inoue T, Konno R, Niwa A, Zaitsu K. Determination of free D-aspartic acid, D-serine and D-alanine in the brain of mutant mice lacking D-amino acid oxidase activity. J Chromatogr B Biomed Sci Appl 2001; 757:119-25. [PMID: 11419736 DOI: 10.1016/s0378-4347(01)00131-1] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A simple and precise method for the simultaneous determination of free D-aspartic acid, D-serine and D-alanine in mouse brain tissues was established, using a reversed-phase HPLC system with widely used pre-column derivatizing reagents, o-phthaldialdehyde and N-t-butyloxycarbonyl-L-cysteine. With the present method, the contents of these three D-amino acids in hippocampus, hypothalamus, pituitary gland, pineal gland and medulla oblongata as well as cerebrum and cerebellum of mutant mice lacking D-amino-acid oxidase activity were determined and compared with those obtained for control mice. In both mice, extremely high contents of D-serine were observed in forebrain (100-400 nmol/g wet tissue), and the contents were small in pituitary and pineal glands. While, D-serine contents in cerebellum and medulla oblongata of mutant mice were about ten times higher than those in control mice. In contrast, D-alanine contents in mutant mice were higher than those in control mice in all brain regions and serum.
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Affiliation(s)
- A Morikawa
- Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
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48
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Hayashi E, Niwa A, Narita Y, Kuzuhara S. [A case of sarcoidosis with simultaneous involvement of the lower brainstem and the whole cervical cord and the extraocular muscles]. Rinsho Shinkeigaku 2001; 41:314-7. [PMID: 11771162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
We report a 63-year-old woman with sarcoidosis which involved the spinal cord, lower brainstem and extraocular muscules simultaneously. In this patient, uveitis developed in 1991 and the skin lesion in 1992. A biopsy of the skin lesion showed changes consistent with sarcoidosis. The ocular and dermal symptoms improved with oral corticosteroid. In October 1997, she noted the left blepharoptosis and numbness of the hands. The MRI showed diffuse swelling of the lower brainstem and the cervical and upper thoracic cord. These lesions showed high intensity signal on T2WI and low intensity signal on T1WI. T1WI with contrast enhancement revealed localized enhancement within the spinal lesion at the C4/5 level. The ocular MRI showed swelling of the left superior rectus muscle and upper levator palpebral muscle. The steroid pulse therapy and subsequent oral administration of prednisolone markedly improved the clinical symptoms. MRI after treatment showed marked improvement of both the spinal cord and ocular muscle lesions. To our knowledge, the simultaneous occurrence of myelopathy and symptomatic extraocular musculopathy in the condition has not been reported previously.
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Affiliation(s)
- E Hayashi
- Department of Neurology, Mie University School of Medicine
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Abstract
We have previously shown that immunization with a synthetic peptide that contains a single CD4(+) T-cell epitope protects mice against immunosuppressive Friend retrovirus infection. Cells producing infectious Friend virus were rapidly eliminated from the spleens of mice that had been immunized with the single-epitope peptide. However, actual effector mechanisms induced through T-helper-cell responses after Friend virus inoculation were unknown. When cytotoxic effector cells detected in the early phase of Friend retrovirus infection were separated based on their expression of cell surface markers, those lacking CD4 and CD8 but expressing natural killer cell markers were found to constitute the majority of effector cells that lysed Friend virus-induced leukemia cells. Depletion of natural killer cells by injecting anti-asialo-ganglio-N-tetraosylceramide antibody did not affect the number of CD4(+) or CD8(+) T cells in the spleen, virus antigen-specific proliferative responses of CD4(+) T cells, or cytotoxic activity against Friend virus-induced leukemia cells exerted by CD8(+) effector cells. However, the same treatment markedly reduced the killing activity of CD4(-) CD8(-) effector cells and completely abolished the effect of peptide immunization. Although the above enhancement of natural killer cell activity in the early stage of Friend virus infection was also observed in mice given no peptide, these results have demonstrated the importance and requirement of natural killer cells in vaccine-induced resistance against the retroviral infection.
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Affiliation(s)
- N Iwanami
- Department of Immunology, Kinki University School of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
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Handa S, Nakano T, Yamashina I, Niwa A, Ishikawa T. [Diagnosis and treatment of acute pulmonary thromboembolism: discussion]. Nihon Naika Gakkai Zasshi 2001; 90:296-311. [PMID: 11307291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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