Next-Generation Sequencing for Non-Ampullary Duodenal Carcinoma Suggesting the Existence of an Adenoma-Carcinoma Sequence

Duodenal tumors with a sporadic adenoma-carcinoma sequence are extremely rare. For such clinically suspected cases without a specific family history, performing a comprehensive gene search is important to understand the germline mutation background. We present a 68-year-old woman without a genetic or familial history of familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome, or Lynch syndrome who presented to Kosei Hospital, Japan, with exertional dyspnea induced by abdominal pain lasting 3 weeks. A duodenal tumor was suspected by contrast-enhanced computed tomography. Esophagogastroduodenoscopy showed a lesion accompanied by a white microprotuberance on the descending part of the duodenum opposite the papilla, with a giant ulcerative lesion at the center of the white lesion. Biopsy revealed a low-grade adenoma, high-grade adenoma, and adenocarcinoma. Immunohistochemical analysis of the adenoma and adenocarcinoma showed Ki-67, p53, cytokeratin 20, caudal-type homeobox 2, and carcinoembryonic antigen positivity and cytokeratin 7 negativity. The findings suggested the presence of an adenoma-adenocarcinoma sequence in duodenal carcinoma. However, in the mutational analysis using next-generation sequencing, c.4348C>T (p.Arg1450Ter) mutation in APC was detected in all normal mucosal, adenoma, and carcinoma tissues. This mutation is common in FAP patients. Even if the presence of an adenoma-adenocarcinoma sequence in duodenal carcinoma is suggested in cases without a familial FAP history, as in this case, genetic analysis may reveal FAP. Thus, performing a comprehensive genetic analysis of duodenal carcinoma patients with a possible adenoma-carcinoma sequence is necessary to explore their genetic background.

Gastropathy associated with lanthanum phosphate deposition that was endoscopically tracked for 3 years. A case report

Background

With the recent increased use of lanthanum carbonate, several cases of lanthanum phosphate deposition to gastric mucosa in dialysis patients have been reported. However, the endoscopic appearance of the early-stage lesion and the over-time alterations of endoscopic findings due to the progression of lanthanum phosphate deposition remain unclear.

Case presentation

An 80-year-old man receiving dialysis and taking lanthanum carbonate as a phosphate binder over a 4-year period underwent upper gastrointestinal endoscopy four times beginning 1 year after initiation of treatment. The first endoscopic examination (after 1 year of exposure to lanthanum carbonate) revealed rough mucosa with a few areas of white granular mucosa. Over the 3 years of endoscopic follow-up, the white granular mucosa spread and multiple erosions appeared. Histopathological findings of biopsy specimens from an erosion showed extensive infiltration by histiocytes containing deposits. Scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDX) revealed that the presence of the deposits containing phosphorus and lanthanum in the gastric mucosa.

On the basis of these results, the patient was diagnosed with gastropathy associated with lanthanum phosphate deposition.

Conclusions

Over a 3-year period, endoscopic findings associated with lanthanum deposition gradually changed and expanded from the early stage.

Parenting and Family Support in Japan for 6- to 8-year-old Children Weighing under 1000 Grams at Birth

The purpose of this study was to explore the variables related to paternal involvement in the caregiving of 6- to 8-year-old extremely low-birthweight (ELBW) children, specifically, sociodemographic factors related to the family or individual biological factors related to ELBW. Thirty-three children with a mean birthweight of 845.5 grams and a mean gestational age of 27.4 weeks participated in this research. Approximately 29% of their fathers were classified by the mothers as nonco-operative in overall child care. The paternal involvement in caregiving was related to the sociodemographic variables of the family; the co-operative fathers were proportionally more often from families where the child had no older female sibling(s) and/or grandparent(s), whereas the nonco-operative fathers were proportionally more often from families where the child had older female sibling(s) and/or grandparent(s). The individual perinatal risk variables and IQ, and the paternal variables (age, socioeconomic status) were not related to the paternal co-operativeness. Our sample mothers seemed to have raised their children in more difficult parenting and economic situations, and to have received proportionally more support from grandparent(s) than did typical Japanese mothers. The children's relationships with peers differed between the paternal co-operative and nonco-operative groups; there were proportionally more children from the nonco-operative group who preferred to play alone than to play with peer(s) at the ages of 3-5 years. Thus, scarce paternal involvement in the process of caregiving appeared to influence the children's sociability.

Gli2 protein expression level is a feasible marker of ligand-dependent hedgehog activation in pancreatic neoplasms

The hedgehog pathway is known to promote proliferation of pancreatic ductal adenocarcinoma (PDA) and has been shown to restrain tumor progression. To understand how hedgehog causes these effects, we sought to carefully examine protein expression of hedgehog signaling components during different tumor stages. Genetically engineered mice, Pdx1-Cre;LSL-KrasG12D and Pdx1-Cre;LSL-KrasG12D;p53lox/+, were utilized to model distinct phases of tumorigenesis, pancreatic intraepithelial neoplasm (PanIN) and PDA. Human pancreatic specimens of intraductal papillary mucinous neoplasm (IPMN) and PDA were also employed. PanIN and IPMN lesions highly express Sonic Hedgehog, at a level that is slightly higher than that observed in PDA. GLI2 protein is also expressed in both PanIN/IPMN and PDA. Although there was no difference in the nuclear staining, the cytoplasmic GLI2 level in PDA was modest in comparison to that in PanIN/IPMN. Hedgehog interacting protein was strongly expressed in the precursors, whereas the level in PDA was significantly attenuated. There were no differences in expression of Patched1 at early and late stages. Finally, a strong correlation between Sonic Hedgehog and GLI2 staining was found in both human and murine pancreatic tumors. The results indicate that the GLI2 protein level could serve as a feasible marker of ligand-dependent hedgehog activation in pancreatic neoplasms.

Electron and Ion Heating Characteristics during Magnetic Reconnection in the MAST Spherical Tokamak

Electron and ion heating characteristics during merging reconnection start-up on the MAST spherical tokamak have been revealed in detail using a 130 channel yttrium aluminum garnet (YAG) and a 300 channel Ruby-Thomson scattering system and a new 32 chord ion Doppler tomography diagnostic. Detailed 2D profile measurements of electron and ion temperature together with electron density have been achieved for the first time and it is found that electron temperature forms a highly localized hot spot at the X point and ion temperature globally increases downstream. For the push merging experiment when the guide field is more than 3 times the reconnecting field, a thick layer of a closed flux surface form by the reconnected field sustains the temperature profile for longer than the electron and ion energy relaxation time ~4-10 ms, both characteristic profiles finally forming a triple peak structure at the X point and downstream. An increase in the toroidal guide field results in a more peaked electron temperature profile at the X point, and also produces higher ion temperatures at this point, but the ion temperature profile in the downstream region is unaffected.

Completion phenomenon in transcortical sensory aphasia

We investigated completion phenomenon for proverbs in cases demonstrating transcortical sensory aphasia due to a variety of diseases. Lack of this completion was exclusively observed in patients with focal atrophy. These patients showed a selective and consistent impairment in word comprehension without phonemic cue effects in naming. The completion phenomenon was present in patients demonstrating transcortical sensory aphasia due to other cerebral diseases. In these patients, comprehension deficits were not selective for words, or words not comprehended were inconsistent and some phonemic cue effects were observed. In a previous study, we reported that completion phenomena for multiplication tables, serial numbers and names of days were frequently noted in patients with focal atrophy. Together with the present findings, these results suggest that lack of proverb completion may be attributed to a selective, systematic and complete loss of the meaning representations for language units such as words and proverbs. In addition, pathological processes of focal atrophy with temporal predominance might selectively affect the semantic memory for language as a unit.

microRNA-18a induces apoptosis in colon cancer cells via the autophagolysosomal degradation of oncogenic heterogeneous nuclear ribonucleoprotein A1

It is well known that microRNAs (miRs) are abnormally expressed in various cancers and target the messenger RNAs (mRNAs) of cancer-associated genes. While (miRs) are abnormally expressed in various cancers, whether miRs directly target oncogenic proteins is unknown. The present study investigated the inhibitory effects of miR-18a on colon cancer progression, which was considered to be mediated through its direct binding and degradation of heterogeneous nuclear ribonucleoprotein A1 (hnRNP A1). An MTT assay and xenograft model demonstrated that the transfection of miR-18a induced apoptosis in SW620 cells. A binding assay revealed direct binding between miR-18a and hnRNP A1 in the cytoplasm of SW620 cells, which inhibited the oncogenic functions of hnRNP A1. A competitor RNA, which included the complementary sequence of the region of the miR-18a-hnRNP A1 binding site, repressed the effects of miR-18a on the induction of cancer cell apoptosis. In vitro single and in vivo double isotope assays demonstrated that miR-18a induced the degradation of hnRNP A1. An immunocytochemical study of hnRNP A1 and LC3-II and the inhibition of autophagy by 3-methyladenine and ATG7, p62 and BAG3 siRNA showed that miR-18a and hnRNP A1 formed a complex that was degraded through the autophagolysosomal pathway. This is the first report showing a novel function of a miR in the autophagolysosomal degradation of an oncogenic protein resulting from the creation of a complex consisting of the miR and a RNA-binding protein, which suppressed cancer progression.

Ion and electron heating characteristics of magnetic reconnection in a two flux loop merging experiment

Characteristics of the high-power reconnection heating were measured for the first time directly by two-dimensional measurements of ion and electron temperatures. While electrons are heated mainly inside the current sheet by the Ohmic heating power, ions are heated mainly by fast shock or viscosity damping of the reconnection outflow in the two downstream areas. The magnetic reconnection converts the energy of reconnecting magnetic field B(p) mostly to the ion thermal energy, indicating that the reconnection heating energy is proportional to B(p)(2).

Surface Modification of Si Field Emitter Arrays for Vacuum Sealing

Vacuum packaging is a very important issue for vacuum microelectronics devices, especially for field emission displays. Emission current from the field emitter array (FEA), however, is known to decrease significantly after the vacuum packaging process. The current decrease is caused by heating treatment in the vacuum sealing process. In the present paper, the effect of the heating treatment on Si FEA was investigated and CHF3 plasma treatment was proposed for avoiding the problem. The Si FEA was exposed to plasma for 15sec and emission characteristics were measured before and after the vacuum sealing process using frit. It was confirmed that CHF3 plasma treatment was very effective for avoiding the emission degradation of the Si FEA. Details of the heating damage and CHF3 plasma treatment are described.

Genetic variants of phosvitin in egg yolk of the Japanese quail, Coturnix coturnix japonica

Phosvitin polymorphism in egg yolk of the Japanese quail was found by horizontal polyacrylamide gradient gel electrophoresis. Six phenotypes of yolk phosvitin designated A, B, C, AB, AC, and BC were observed in a population of 281 birds. Analysis of family data revealed that the phenotypic variation of quail yolk phosvitins was controlled by an autosomal Pv locus with three codominant alleles, Pva, Pvb and Pvc. The gene frequencies of Pva, Pvb and Pvc were 0.064, 0.824 and 0.112, respectively.

[Experience of chest wall reconstruction with newly developed material]

After the chest wall resection, its reconstruction is often needed. A 45-year-old male lung adenocarcinoma patient with chest wall invasion underwent upper lobectomy of the right lung with partial resection of 4-6th ribs. The size of the removed chest wall was 11 x 6.5 cm. We reconstructed the chest wall with Bard Composix E/X Mesh. This prosthesis is consisted of a polypropylene mesh and an expanded polytetrafluoroethylene sheet This material is seems to be useful in the reconstruction of chest wall in both preventing pulmonary adhesion and enabling good wound healing.

Diffusion tensor imaging in chronic subdural hematoma: correlation between clinical signs and fractional anisotropy in the pyramidal tract

BACKGROUND AND PURPOSE

Diffusion tensor imaging (DTI) was introduced as a good technique to evaluate structural abnormalities in the white matter. In this study, we used DTI to examine anisotropic changes of the pyramidal tracts displaced by chronic subdural hematoma (CSDH).

MATERIALS AND METHODS

Twenty-six patients with unilateral CSDH underwent DTI before and after surgery. We measured fractional anisotropy (FA) values in pyramidal tracts of bilateral cerebral peduncles and calculated the ratio of the FA value on the lesion side to that on the contralateral side (FA ratio) and compared the ratios with motor weakness. Moreover, the relationships between FA ratios and clinical factors such as age, sex, midline shift, interval from trauma, and hematoma attenuation on CT were evaluated.

RESULTS

FA values of pyramidal tracts on the lesion side were significantly lower than those on the contralateral side (0.66 +/- 0.07 versus 0.74 +/- 0.05, P < .0001). The FA ratio was correlated to the severity of motor weakness (r(2) = 0.32, P = .002). FA ratios after surgery improved significantly compared with those before surgery (0.96 +/- 0.08 versus 0.89 +/- 0.07, P = .0004). Intervals from trauma and the midline shift were significantly associated with decreased FA ratios (P = .0008 and P = .037).

CONCLUSIONS

In patients with CSDH, a reversible decrease of FA in the affected pyramidal tract on DTI was correlated to motor weakness. These anisotropic changes were considered to be caused by a reversible distortion of neuron fibers and vasogenic edema due to the hematoma.

K-ras mutations and cell kinetics in Helicobacter pylori associated gastric intestinal metaplasia: a comparison before and after eradication in patients with chronic gastritis and gastric cancer

BACKGROUND

Helicobacter pylori related gastric intestinal metaplasia (IM) is considered to be a precancerous lesion.

AIMS

To identify the effects of H pylori eradication on K-ras mutations, cell kinetics in IM and histological changes in patients with and without gastric cancers in a one-year prospective study.

METHODS

Patients included group A (n = 39), chronic gastritis, and group B (n = 53), intestinal-type early gastric cancer patients who had all undergone endoscopic mucosal resection (n = 25) or surgical resection (n = 28). K-ras codon 12 mutations in IM were examined, followed by DNA sequencing analysis. Proliferating and apoptotic cells were detected with anti-Ki-67 antibody and using the TUNEL method, respectively.

RESULTS

The incidence of K-ras mutations in the cancer was only 3.8%. The mutant K-ras in IM was observed more frequently in group A (46.2%) than in group B patients (1.9%) (p<0.005). After eradication, the K-ras mutations significantly declined to 12.8% in group A (p<0.005). The mutation pattern of K-ras codon 12 before eradication was that GGT was mainly changed to AGT (50%) in group A. AGT transformation was not affected by treatment. Apoptosis in IM showed an increase after H pylori eradication in both groups (p<0.05 in group A) although no histological improvement in IM was observed. The monocyte score was significantly higher in group A than in group B (p<0.05); the score improved significantly after eradication.

CONCLUSIONS

K-ras mutations in IM do not always play a role in gastric carcinogenesis but cell kinetics, especially apoptosis, in IM may contribute to it. There are early events in K-ras mutations which are influenced by H pylori infection; some mutations may also be selected by eradication. These unstable K-ras mutations in IM may be related to lymphocyte infiltration caused by H pylori infection.

CA125 nadir as a prognostic factor in advanced ovarian carcinoma: A retrospective study of 84 patients achieving clinical CR

5060

Background: There have been few reports of the relationship between CA125 nadir and the prognosis in patients with advanced ovarian carcinoma (AOC) who achieve a complete clinical response by multivariate analysis. Methods: CA125 nadir and the prognosis after the initial therapy (debulking surgery + first line chemotherapy) were retrospectively investigated in patients (pts) who had AOC meeting the criteria below and received therapy at National Cancer Center Hospital, between 1998 and 2004. The eligibility criteria were: 1) histological diagnosis of mullerian carcinoma, 2) FIGO stages III and IV, 3) a combination of platinum and taxane was administered as the first line chemotherapy, and 4) achieved clinically defined complete response (CR) after the initial therapy (ie, no cancer-related symptoms; normal physical examination, computed tomography scan of the abdomen/pelvis and chest x-ray). The possibility of CA125 nadir being a prognostic factor was investigated in pts who met these criteria by multivariate analysis (age (<50 years or 50 years≤), stage (III or IV), histological type (serous adenocarcinoma (serous) or non-serous), residual tumor diameter (<2 cm or 2 cm≤) and CA125 nadir (<10 U/ml or 10 U/ml≤)) using the Cox regression model. Results: There were 84 pts with a median age of 55.5 years (26–74). The stage was III in 59 pts and IV in 25 pts, the histological type was serous in 71 pts and non-serous in 13pts, and the residual tumor diameter was <2 cm in 72 pts and >2 cm in 12 pts and the median of CA125 before the initial therapy was 535 U/ml (13–28190), the CA125 nadir was <10 U/ml in 54 pts and 10 U/ml≤ in 30 pts, respectively. Regarding the prognosis, the median progression free survival (PFS) was 19 months (6–82), and the median overall survival (OS) was 36.5 months (10–82). By multivariate analysis, the CA125 nadir was significantly associated with the prognosis (hazard ratio of PFS was 0.39 (95% CI, 0.21–0.71), hazard ratio of OS was 0.28 (95% CI, 0.11–0.72)). Conclusion: CA125 nadir is a prognostic factor in patients with AOC who achieved clinically defined CR after the initial therapy, when the cut-off value was set to 10 U/ml. CA125 nadir may be an important factor for identifying pts for whom maintenance chemotherapy is effective.

[Table: see text]

Analysis of third-line and fourth-line chemotherapy for recurrent ovarian cancer treated with first-line platinum/taxane regimens

15045

Background: Limited information is available regarding to the usefulness of third-line chemotherapy (TLC) and forth-line chemotherapy (FLC) for recurrent ovarian cancer treated with first-line platinum/taxane (PT) regimens. Methods: We retrospectively reviewed the medical records of patients (pts) with ovarian cancer treated with PT regimens at the National Cancer Center Hospital from 1998 to 2004. The aim of this study is to investigate the important clinical factor such as response rate (RR), time to treatment progression (TTP), overall survival (OS) and predictor of response to TLC and FLC. Kaplan-Meier method was used for estimating TTP and OS. Wilcoxon test was performed for survival times and p-values < 0.05 were considered to be statistically significant. Results: There were 183 pts received first-line PT regimens in study period, 77 of 183 pts received second-line chemotherapy (SLC), 61 of 77 progressed after SLC and 55 of 61 pts received TLC. The RR to TLC was 34.5%. The median TTP was 5 months (mo) (range; 1–19 mo) and the median OS was 12 mo (range; 2–38 mo). The TLC regimen was consisted of P and/or T regimens of 36 pts and the other regimens of 19 pts. The RR according to the duration of response of previous chemotherapy (DRPC) (< 6 mo and ≥ 6 mo) were 31.4% and 37.3%, respectively. The median OS of DRPC (< 6 mo and ≥ 6 mo) were 8 mo (range; 2–33 mo) and 12 mo (range; 2–38 mo), respectively (p = 0.002). After TLC 47 pts progressed and 29 pts received FLC. The RR to FLC was 27.5%. The median TTP was 3 mo (range; 0–11 mo). The median OS of 18 pts who didn’t receive FLC and 29 pts received FLC were 2 mo (range; 2–16 mo) and 7 mo (range; 2–25 mo), respectively (p = 0.01). The RR according to DRPC (< 4 mo and ≥ 4mo) were 22.2% and 30%, respectively. The median OS of DRPC (< 4 mo and ≥ 4 mo) were 3 mo (range; 2–23 mo) and 6 mo (range; 2–25 mo), respectively (p = 0.4). Conclusions: The DRPC is considered to be predictor of response to TLC but not to FLC. Giving TLC and FLC if the pts have tolerable may improve OS, however this analysis is prone to several well-established potential biases and limitations. Further prospective study is warranted.

[Table: see text]

Selective inhibition of vascular smooth muscle cell proliferation by coptisine isolated from Coptis rhizoma, one of the crude drugs composing Kampo medicines Unsei-in

Acceleration of vascular smooth muscle cell (VSMC) proliferation is closely linked to the pathogenesis of vascular diseases. We, therefore, focused on traditional Japanese herbal medicines (Kampo medicines) used to ameliorate the impairment of microcirculation or blood stasis and screened them for their ability to inhibit rat VSMC proliferation. Among them, Unsei-in was found to effectively suppress VSMC proliferation, and Coptis rhizome was the responsible constituent crude drug. The extract of Coptis rhizome inhibited VSMC proliferation with the GI(50) value of 4.4 microg/ml, which was much lower than those against the proliferation of 3Y1, dRLh-84, B16, and HeLa cells. The Coptis rhizome extract inhibited the progression of VSMC arrested at G(0)/G(1) phase from G(0)/G(1) to S phase, but not that of 3Y1 cells. Biological assay-guided fractionation revealed that an alkaloid of Coptis rhizome, coptisine, was the active ingredient in selectively preventing VSMC proliferation with GI(50) of 3.3 microM (1.2 microg/ml). When the structurally-related isoquinoline alkaloids of protoberberine class were studied for their inhibitory activities, berberine decreased the VSMC proliferation with GI(50) of 95.1 microM (35.4 microg/ml), about 30 times higher concentration than coptisine, while palmatine failed to show any activity. This study provides evidence that coptisine, an ingredient of Unsei-in, prevents VSMC proliferation selectively at lower concentrations compared with various cells or other structurally related alkaloids.

Correlation of visual hallucinations with occipital rCBF changes by donepezil in DLB

The authors explored the neural substrate of visual hallucinations in dementia with Lewy bodies (DLB) by investigating changes in regional cerebral blood flow (rCBF) and psychiatric symptoms, before and after cholinesterase inhibitor treatment. Twenty subjects with DLB were treated with donepezil for a 12-week period. Hallucinations attenuated while receiving therapy, whereas occipital rCBF focally increased, suggesting that functional visual association cortex deficits may cause visual hallucinations in patients with DLB.

Double blockade of cell cycle progression by coptisine in vascular smooth muscle cells

Coptisine, an isoquinoline alkaloid isolated from rhizome of Coptis japonica, inhibits proliferation of vascular smooth muscle cells (VSMCs). The aim of this study was to evaluate the action of coptisine, along with berberine (a structurally similar isoquinoline alkaloid), on progression of the cell cycle in VSMCs. Coptisine displayed antiproliferative action against VSMCs by blocking the cell cycle at G(1) and G(2)/M phases. The G(1) block was shown by inhibition of [(3)H]thymidine incorporation into VSMCs at coptisine concentrations higher than 15 microM. The mechanism underlying the G(1) arrest involved a decrease in cyclin D1 protein, although cyclin E, A, and B were not affected by coptisine treatment. The selective reduction in cyclin D1 protein was mainly attributable to accelerated proteolysis via proteasome-dependent pathway, since it was inhibited by a proteasome inhibitor, N-carbobenzoxy-L-leucinyl-L-leucinyl-L-norleucinal (MG132) and further the mRNA level of cyclin D1, protein synthesis, and mitogen-activated protein kinase (MAPK) activity remained unaltered. The mechanism underlying the G(2)/M arrest involved partial inhibition of tubulin polymerization, which was apparent at coptisine concentration of 3 microM. Berberine arrested the cell cycle at G(1) phase via a mechanism identical with coptisine, but did not cause block at G(2)/M phase. The results demonstrate that a small difference in the structure between isoquinoline alkaloids produces a big difference in activity, and that coptisine has a unique double action in arresting the cell cycle of VSMCs.

[Aortic root remodeling and coronary artery bypass grafting for acute type A aortic dissection involving the left main coronary artery; report of a case]

A 56-year-old male was admitted for sudden chest pain followed by loss of consciousness and paraplegia. The electrocardiogram (ECG) revealed ST-elevation in leads II, III, and aVF and ST-depression in leads V3 to V6. The ultrasonic cardiography (UCG) demonstrated an intimal flap in the ascending aorta, grade III aortic regurgitation (AR), and akinesis of the posterior wall of the left ventricle. Transesophageal echocardiography directly showed dissection of the left main coronary artery. Emergency coronary artery bypass grafting (CABG) to the left anterior descending artery (LAD), obtuse marginal artery (OM) and posterolateral artery (PL) was performed using the saphenous vein. In addition, valve-sparing aortic root remodeling was performed in conjunction with replacement of the ascending aorta. The left coronary orifice was repaired and reattached to the prosthetic graft. The patient was weaned from cardiopulmonary bypass without catecholamine support. He was discharged from the hospital on foot after rehabilitation of the paraplegia. AR remains mild by UCG 3 years after surgery.

Inter- and intra-specific gene-density-correlated radial chromosome territory arrangements are conserved in Old World monkeys

Recently it has been shown that the gene-density correlated radial distribution of human 18 and 19 homologous chromosome territories (CTs) is conserved in higher primates in spite of chromosomal rearrangements that occurred during evolution. However, these observations were limited to apes and New World monkey species. In order to provide further evidence for the evolutionary conservation of gene-density-correlated CT arrangements, we extended our previous study to Old World monkeys. They comprise the remaining species group to be analyzed in order to obtain a comprehensive overview of the nuclear topology of human 18 and 19 homologous CTs in higher primates. In the present study we investigated four lymphoblastoid cell lines from three species of Old World monkeys by three-dimensional fluorescence in situ hybridization (3D-FISH): two individuals of Japanese macaque (Macaca fuscata), crab-eating macaque (Macaca fascicularis), and an interspecies hybrid individual between African green monkey (Cercopithecus aethiops) and Patas monkey (Erythrocebus patas). Our data demonstrate that gene-poor human 18 homologous CTs are located preferentially close to the nuclear periphery, whereas gene-dense human 19 homologous CTs are oriented towards the nuclear center in all cell lines analyzed. The gene-density-correlated positioning of human 18 and 19 homologous CTs is evolutionarily conserved throughout all major higher primate lineages, despite chromosomal inversions, fusions, fissions or reciprocal translocations that occurred in the course of evolution in these species. This remarkable preservation of a gene-density-correlated chromatin arrangement gives further support for a functionally relevant higher-order chromatin architecture.

The comparison between pains, difficulties in function, and associating factors of patients in subtypes of temporomandibular disorders

The aim of this study was to compare the multidimensional properties among subtypes of painful temporomandibular disorders (TMD): myofascial pain (group I), disc displacement (group II), arthralgia (group IIIa) and osteoarthritis (group IIIb). A total of 511 patients answered a battery of questionnaires, which included questions relating to intensity and duration of pain, the Japanese version of the McGill Pain Questionnaire, limitation of daily functions, the Hospital Anxiety and Depression Scale, the Eysenck Personality Questionnaire short-form and 34 items of behavioural contributing factors. Group IIIb showed significantly the highest age in all subtypes. Those in group I had higher depression scores than those in group II (P = 0.005). Group IIIa had a lower women's ratio than in group II (P = 0.001) and the patients showed a shorter pain duration than those in groups I (P = 0.000) and II (P = 0.001). Group IIIa patients also showed lower visual analogue scale (VAS) ratings for pain descriptors 'heavy' (P = 0.002) and 'tiring' (P = 0.004) than those of group I, and 'dull' (P = 0.005), 'heavy' (P = 0.001) and 'tiring' (P = 0.005) than those of group II. Group IIIa showed lower ratios of contributing factors of 'an awareness of grinding/clenching during sleep' (P = 0.000) and 'an awareness of clenching sensation when waking up at night' (P = 0.002) than those of group I, and also showed a higher ratio of 'a liking for a hard food' (P = 0.000) and lower ratio of 'talking for a long time on the telephone' (P = 0.001) than those of group II. In conclusion, although several properties were different between subtypes, the majority of them were similar in the four subtypes of TMD.

[Infective endocarditis caused by methicillin resistant Staphylococcus aureus following corticosteroid pulse therapy; report of a case]

A 51-year-old man, with a history of corticosteroid pulse therapy 3 weeks previously, developed infective endocarditis of the mitral valve due to methicillin resistant Staphylococcus aureus, and underwent mitral valve replacement. Since the second postoperative day, clinical course was seriously complicated because of recurrent abdominal pain corresponding with commencement of oral intake, unremitting spike fever, and renal and hepatic dysfunction. Various examinations except angiography failed to demonstrate the etiology. Two months later, the patient developed panperitonitis due to perforation of ischemic ulcer of the cecum and underwent ileo-cecal resection. After this operation, he convalesced very quickly. Ischemia is one of the main causes of abdominal complication following cardiac surgery. Angiography should be positively considered in cases like the present one.

Dementia associated mental and behavioural disturbances in elderly people in the community: findings from the first Nakayama study

OBJECTIVE

To determine the prevalence of mental and behavioural disturbances associated with dementia in elderly people living in the Japanese community of Nakayama.

METHODS

A door to door three phase population survey was carried out on all persons aged 65 years and older living at home. The study included a psychiatric interview, neurological and neuropsychological examination, and cranial computed tomography. Participants with dementia were rated on the neuropsychiatric inventory.

RESULTS

Of 1438 inhabitants, 1162 (81.0%) completed the protocol. The prevalence of dementia was 4.8%. Of the 60 participants with dementia (Alzheimer's disease 35%, vascular dementia 47%, and dementia from other causes 17%), 53 (88.3%) had shown one or more mental and behavioural disturbances. Apathy/indifference (56.7%), followed by agitation/aggression (35%), aberrant motor behaviour (31.7%), and irritability (31.7%) were the common symptoms. More productive (positive) symptoms such as delusions and aberrant motor behaviour were found in the Alzheimer group than in the vascular dementia group.

CONCLUSIONS

A wide range of dementia associated mental and behavioural disturbances developed in the majority of community dwelling individuals with dementia. The findings suggest that a screening programme focusing on identifying these symptoms should be included in the physician's diagnostic tools for dementia.

Synthesis of Seoul virus RNA and structural proteins in cultured cells

Seoul virus is a hantavirus that causes hemorrhagic fever with renal syndrome (HFRS). The virion has a tripartite (S, M, and L) negative-stranded RNA genome, which is characteristic of the family Bunyaviridae. However, the molecular basis of virus replication is not well known. We established a Northern blot hybridization (NB) procedure using digoxygenin-labeled RNA probes, to quantitate the hantaviral plus- and minus-strand RNAs separately. Virus RNA replication was analyzed in infected Vero E6 cells. When the Vero E6 cells were infected with Seoul virus strain KI-83-262 (KI) at m.o.i. = 0.25, the plus-strand RNA was detected within 1 h post-infection (hpi), and the minus-strand RNA was detected subsequently. Using laser confocal microscopy, the nucleocapsid protein (NP) was detected within 2 hpi, and accumulated as scattered granules in the cytoplasm until 24 hpi. In contrast, the G2 protein first appeared at 8 hpi, was immediately transported to the Golgi, and accumulated in the Golgi until 24 hpi. Infectious virus particles were released into the medium at 24 h hpi. These findings indicate that hantavirus RNA replication starts with the appearance of NP at 2 hpi, glycoproteins then accumulate gradually in the Golgi, and virion formation is initiated once the viral RNAs and proteins have accumulated.

Gastric intestinal metaplasia as detected by a monoclonal antibody is highly associated with gastric adenocarcinoma

BACKGROUND

Some forms of gastric intestinal metaplasia (GIM) may be precancerous but the cellular phenotype that predisposes to gastric carcinogenesis is not well characterised. Mucin staining, as a means of differentiating GIM, is difficult. A monoclonal antibody, mAb Das-1 (initially called 7E(12)H(12)), whose staining is phenotypically specific to colon epithelium, was used to investigate this issue.

METHODS

Using mAb Das-1, by a sensitive immunoperoxidase assay, we examined histologically confirmed GIM specimens from two countries, the USA and Japan. A total of 150 patients comprised three groups: group A, GIM (fields away from the cancer area) from patients with gastric carcinoma (n=60); group B, GIM with chronic gastritis (without gastric carcinoma) (n=72); and group C, chronic gastritis without GIM (n=18).

RESULTS

Fifty six of 60 (93%) patients with GIM (both goblet and non-goblet metaplastic cells) from group A reacted intensely with mAb Das-1. Cancer areas from the same 56 patients also reacted. In contrast, 25/72 (35%) samples of GIM from patients in group B reacted with mAb Das-1 (group A v B, p<0.0001). None of the samples from group C reacted with the mAb.

CONCLUSIONS

Reactivity of mAb Das-1 is clinically useful to simplify and differentiate the phenotypes of GIM. The colonic phenotype of GIM, as identified by mAb Das-1, is strongly associated with gastric carcinoma.

[Resection of freely mobile atheroma in the ascending aorta under circulatory arrest during coronary artery bypass grafting surgery]

A 52-year-old male with a 13 years history of hemodialysis developed unstable angina. Preoperative examination revealed critical stenoses in 3 coronary arteries and extensive calcification in the ascending aorta. During urgent coronary artery bypass surgery, epiaortic ultrasonography demonstrated a large and markedly mobile atheroma in the ascending aorta. Therefore, he underwent resection of this atheroma using cardiopulmonary bypass and circulatory arrest. His postoperative course was fine. This aggressive strategy for a diseased aorta can be a viable option in selected cases. Epiaortic ultrasonography appeared to be indispensable during surgery for patients like a present one.

[Coronary artery aneurysm developed acute myocardial infarction: report of a case]

A 68-year-old woman without angina developed acute antero-septal myocardial infarction. Coronary angiogram revealed saccular coronary artery aneurysm at the origin of the diagonal branch and relatively mild coronary artery stenosis. Emboli from the coronary aneurysm was strongly suggested. We placed coronary bypass grafts onto left anterior descending, diagonal and obtuse marginal branches, and excluded the coronary aneurysm by ligating both its inflow and outflow. The postoperative course was uneventful. There are several treatments of choice for patients with coronary aneurysm. We believe that surgery is mandatory and that exclusion of the coronary aneurysm should be considered in every possible case.