P4432Coronary microvascular dysfunction in inflammatory bowel disease: Restored after enterectomy

Background

Inflammatory bowel disease (IBD) is a complex multisystem disease characterized by chronic inflammation, which can lead to coronary microvascular dysfunction (CMD).

Purpose

We aimed to investigate the presence and the severity of CMD in Crohn's disease (CD) and ulcerative colitis (UC) by assessing coronary flow reserve (CFR) using transthoracic Doppler echocardiography, and to elucidate the influence of enterectomy on CMD.

Methods

Thirty-seven IBD patients (22 CD patients: 39±12 years, 15 UC patients: 52±17 years), and 30 age- and gender-matched control subjects (46±12 years) who have comparable risk factors for coronary artery disease were enrolled. Smokers were excepted from the present study. For CFR measurement, coronary flow velocity was recorded at rest and during hyperemia in the left anterior descending coronary artery induced by intravenous infusion of adenosine triphosphate (0.14 mg/kg/min), and a CFR ≤2.5 calculated as the ratio of hyperemic to basal peak and mean diastolic velocity defined CMD. CFR measurement was repeated before and within 1 year after enterectomy. Serum or plasma cytokines were also measured before and after enterectomy.

Results

The median disease duration of CD and UC patients were 12 and 6 years. Although none of control subjects had CMD, 38% in IBD patients (CD: 41%, UC: 33%) had CMD. CFR was similarly and significantly lower in CD and UC patients than Control subjects (CD: 2.92±1.03*, UC: 2.99±0.65*, and Control: 3.84±0.75, *p<0.05 vs. Control). Serum levels of TNF-α, IL-6 and hs-CRP were significantly higher in CD and UC patients than Control subjects. Multiple linear regression analysis showed that the presence of IBD and mean diastolic flow velocity at baseline were independently associated with reduced CFR among all study participants (β=−0.324 and −0.614, p=0.001, respectively). CFR in IBD patients with both CMD and non-CMD significantly improved after enterectomy, and the extent of CFR improvement was greater in patients with CMD than those with non-CMD (Figure). Serum levels of IL-6 and hs-CRP significantly reduced among all IBD patients.

Conclusion

IBD was associated with CMD, which improved after enterectomy.

Potential identification of vitamin B6 responsiveness in autism spectrum disorder utilizing phenotype variables and machine learning methods

We investigated whether machine learning methods could potentially identify a subgroup of persons with autism spectrum disorder (ASD) who show vitamin B6 responsiveness by selected phenotype variables. We analyzed the existing data from our intervention study with 17 persons. First, we focused on signs and biomarkers that have been identified as candidates for vitamin B6 responsiveness indicators. Second, we conducted hypothesis testing among these selected variables and their combinations. Finally, we further investigated the results by conducting cluster analyses with two different algorithms, affinity propagation and k-medoids. Statistically significant variables for vitamin B6 responsiveness, including combination of hypersensitivity to sound and clumsiness, and plasma glutamine level, were included. As an a priori variable, the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) scores was also included. The affinity propagation analysis showed good classification of three potential vitamin B6-responsive persons with ASD. The k-medoids analysis also showed good classification. To our knowledge, this is the first study to attempt to identify subgroup of persons with ASD who show specific treatment responsiveness using selected phenotype variables. We applied machine learning methods to further investigate these variables' ability to identify this subgroup of ASD, even when only a small sample size was available.

Application of Quick Environment Exposure Sensitivity Inventory (QEESI©) for Japanese population: study of reliability and validity of the questionnaire

A standardized questionnaire has not been established for screening or diagnostic assessment of patients with multiple chemical sensitivity (MCS) in Japan. In the US, Miller and Prihoda (1999a, b) developed a questionnaire that could be used internationally, the Quick Environment Exposure Sensitivity Inventory (QEESI©), to assist researchers and clinicians in evaluating patients and populations for chemical sensitivity. The Japanese version of QEESI©was subsequently translated by Ishikawa and Miyata (1999). The present study was performed to investigate the reliability and validity of QEESI©(Japanese version) for research purposes and for evaluation of patients with MCS in Japan.

A total of 498 subjects were recruited from the general population of Miyagi prefecture, Japan. The factor structure in QEESI©was analyzed with 40 items on four subscales except for the items in ‘Masking’ using principal components analysis with Promax rotation. The results showed that 30 items on three subscales, ‘Chemical Inhalant Intolerances,’ ‘Symptom Severity,’ and ‘Life Impact’ except for ‘Other Intolerances’ were consistent with those reported for the US population by Miller and Prihoda (1999a). Cronbach’s a reliability coefficient ranged between 0.87 and 0.94 indicating high internal consistency in the 30 items on three subscales.

Next, we compared the mean scores on three subscales of QEESI©in two groups: 131 self-reported MCS group who were new outpatients at the Environmental Medical Center in Kitasato Institute Hospital, and 131 members of the general population (controls) who were matched for both gender and age with the self-reported MCS group. Mean scores on each subscale for the self-reported MCS group were significantly greater than those for controls (PB < 0.001). Mean scores on all of the 30 items on three subscales for the self-reported MCS group were also significantly greater than for the controls (PB < 0.001). These findings indicated that the 30 items on three subscales in QEESI©can be used for surveys and for diagnostic assessment of patients with MCS as well as for comparative studies between patients in Japan and in other countries.

Use of QEESI© questionnaire for a screening study in Japan

QEESI© (Miller and Prihoda, 1999a: Toxicology and Industrial Health, 15, 370) was applied to 498 subjects, recruited from the general population of Miyagi prefecture, Japan, who had not been diagnosed previously as having multiple chemical sensitivity (MCS) or sick building syndrome. Seventeen (3.8%) of 440 subjects who returned valid completed questionnaires were classified as having symptoms ‘very suggestive’ of MCS using the four-classification system of Miller and Prihoda (1999a). We conducted detailed telephone interviews with these 17 individuals. All were visiting local hospitals on an outpatient basis with diagnoses other than MCS and had either current or previous presumed chemical exposure. Therefore, we recommended they undergo a medical check by MCS medical experts and indoor air quality assessment.

Seven subjects participated in both the medical check and indoor air quality monitoring, six subjects participated in indoor air quality monitoring only and four subjects participated in neither. The seven subjects who participated in both the medical check and monitoring were diagnosed as having MCS by the above expert physicians. In nine houses of 13 subjects who participated in indoor environmental quality (IEQ) survey, acetaldehyde (9/9), formaldehyde (8/9), total volatile compounds (TVOCs) (6/9) and paradichlorobenzene (3/9) levels were above the respective guideline values for indoor air concentrations, outlined by the Ministry of Health, Labor and Welfare of Japan and were presumed to act as factors contributing to the subjects’ hypersensitivity and onset or development of symptoms.

These results suggested that there might still be a population of patients not properly diagnosed as having MCS by clinicians in Japan. Therefore, we verified the efficacy of QEESI (Japanese version) for screening of MCS patients.

The results of indoor air quality analysis suggested the manifestation and deterioration of MCS in Japan might be precipitated by indoor air pollutants, such as formaldehyde, acetaldehyde, volatile compounds (VOCs) and paradichlorobenzene.

Association of sick building syndrome with neuropathy target esterase (NTE) activity in Japanese

Sick building syndrome (SBS) is a set of several clinically recognizable symptoms reported by occupants of a building without a clear cause. Neuropathy target esterase (NTE) is a membrane bound serine esterase and its reaction with organophosphates (OPs) can lead to OP-induced delayed neuropathy (OPIDN) and nerve axon degeneration. The aim of our study was to determine whether there was a difference in NTE activity in the peripheral blood mononuclear cells (PBMCs) of Japanese patients with SBS and healthy controls and whether PNPLA6 (alias NTE) gene polymorphisms were associated with SBS. We found that the enzymatic activity of NTE was significantly higher (P < 0.0005) in SBS patients compared with controls. Moreover, population with an AA genotype of a single nucleotide polymorphism (SNP), rs480208, in intron 21 of the PNPLA6 gene strongly reduced the activity of NTE. Fifty-eight SNP markers within the PNPLA6 gene were tested for association in a case-control study of 188 affected individuals and 401 age-matched controls. Only one SNP, rs480208, was statistically different in genotype distribution (P = 0.005) and allele frequency (P = 0.006) between the cases and controls (uncorrected for testing multiple SNP sites), but these were not significant by multiple corrections. The findings of the association between the enzymatic activity of NTE and SBS in Japanese show for the first time that NTE activity might be involved with SBS.

Polychlorinated biphenyl levels in the blood of Japanese individuals ranging from infants to over 80 years of age

Individuals' exposure to various persistent organic pollutants (POPs), including polychlorinated biphenyls (PCBs), and its adverse health effects have been a cause of concern. We measured blood PCB concentrations from samples taken from 507 Japanese individuals ranging from infants to those over 80 years of age. The blood PCB levels increased with age for both male (Spearman's r = 0.69, p < 0.001) and female (Spearman's r = 0.70, p < 0.001) participants. Adult men and nulliparous women showed similar increases with age. However, the PCB levels of multiparous women were lower than those of nulliparous women in their thirties (p = 0.005), probably because the PCBs were transferred from the mothers to their children during pregnancy and lactation. Among infants (<2 years of age), some had as high levels of accumulated PCB levels as those in adults >30 years of age. In some cases, the PCB levels were over 0.8 ng/g wet weight, similar to levels observed in adults over 50 years of age. In the future, it will be necessary to do research on the health of the children who are exposed by high concentration level of POPs.

Association study between sick building syndrome and polymorphisms of seven human detoxification genes in the Japanese

Sick building syndrome (SBS) is a chronic disorder caused by exposure to diverse indoor environmental or chemical pollutants. This study examined the association between seven detoxification genes (CYP1A1, CYP2E1, EPHX1, GSTM1, GSTT1, GSTP1, and NAT2) and SBS in the Japanese population. One hundred eighty patients with SBS and 401 healthy controls were enrolled in this study. We examined the prevalence for total of eleven genetic polymorphisms of detoxification genes. However, no statistically significant differences in allele and genotype frequency distributions of eleven genetic polymorphisms of these detoxification genes were found between patients and controls. On this basis, we conclude that the polymorphisms that we assessed for the detoxification genes do not contribute to the etiology of SBS.

Hypothetical thinking on influences of chemicals in the environment and female sex hormones in food on Japanese children

Allergic diseases have rapidly increased in Japan. Changes in the prevalence of bronchial asthma in children and birth years of anaphylactic patients suggest that an event that may have increased allergic diseases occurred in about 1970, and chemicals in the environment and food are considered to be a cause. Some environmental pollutants inhibit the development of the immune system, and such chemicals possibly affect immune development from the fetal period. Female hormones contained in milk, meat and eggs may also affect the development of the immune system after birth. It may be possible that a cause of the current increase in allergic diseases, the disruption of Th1 (T lymphocyte helper type 1)/Th2 (T lymphocyte helper type 2) balance, occurs due to a complex influence of chemicals and excess female hormones, and the development of the immune system may be affected in children in whom hormone production is physiologically low, particularly boys before puberty. The influences of chemicals and sex hormones in food have not been fully investigated, and future studies are expected.

Protective effect of heat shock protein 72 on contractile function of perfused failing heart

The contribution of heat shock protein 72 (HSP72) to the protection of cardiac function was examined in rats with chronic heat failure (CHF) following coronary artery ligation (CAL). The CAL animals revealed functional deterioration without low cardiac output 2 wk after CAL and with low cardiac output 8 wk after CAL, suggesting that CHF had developed by 8 wk after CAL. The hearts isolated from animals 2 and 8 wk after CAL (2-wk CAL heart and 8-wk CAL heart, respectively) were subjected to hyperthermia (at 42 degrees C) for 15 min, followed by 6-h perfusion (hyperthermia/6-h perfusion). The 2-wk CAL heart showed a 19.0 +/- 3.9% decline in the rate- pressure product (RPP) after hyperthermia/6-h perfusion, similar to the nonoperated control (19.8 +/- 2.9% decline). The production of myocardial HSP72 increased in the 2-wk CAL heart in response to hyperthermia (412.7 +/- 29.5% of each prehyperthermia value). The 8-wk CAL heart showed a reduction in the RPP (45.2 +/- 4.3% decline) after hyperthermia/6-h perfusion, associated with blunting of the production of HSP72 (68.9 +/- 22.6% increase, respectively). The results suggest that functional deterioration of the isolated failing heart may be attributed to a reduction in the production of myocardial HSP72.

Development of metal-resin composite restorative material. Part 3. Flexural properties and condensability of metal-resin composite using Ag-Sn irregular particles

Powder-liquid type metal-resin composites, using Ag-Sn irregular particles as the filler, 4-META as coupling agent and UDMA + TEGDMA as resin matrix, were experimentally prepared under 9 different conditions (three different particle sizes and three different filler contents). The flexural strength and flexural modulus were measured. Three different irregular particle size MRCs without redox-initiator at 94% filler content, as well as amalgam, conventional hybrid composite and Ag-Sn spherical particle MRC were evaluated for condensability. The flexural strength of the Ag-Sn irregular particle MRC was significantly influenced by both the filler particle size and filler contents (p < 0.01). It increased when either the filler content increased or the particles size decreased. The highest flexural strength (97.6 MPa) was obtained from the condition of particles size < 20 microns and 94% filler content. The flexural modulus was significantly influenced by filler content and it increased with increasing filler content. The condensability of the Ag-Sn irregular particle MRC was lower than that of amalgam but much higher than presently available conventional composites and spherical particle MRC.

Development of metal-resin composite restorative material. Part 2. Effects of acid and heat treatments of silver-tin filler particles on flexural properties of metal-resin composite

The effects of acid and heat treatments of silver-tin filler particles on the flexural properties of metal-resin composite restorative materials were investigated. Five metal-resin composite restorative materials containing different silver-tin filler particles treated under different conditions were experimentally prepared. The conditions of the alloy particles were; 1) as atomized (NT), 2) 1.8% HCl acid-treated (AT), 3) heat-treated at 150 degrees C for 5 min after AT (A15), 4) heat-treated at 200 degrees C for 5 min after AT (A20) and 5) heat-treated at 250 degrees C for 5 min after AT (A25). The flexural strength and the flexural modulus of elasticity were measured for the five metal-resin composites to evaluate the effects of the acid and heat treatments. The flexural strength of the prepared composites was significantly influenced by the surface condition of the filler particles (p < 0.01), and increased significantly when the as atomized particles (NT) were acid-treated (AT) or acid- and heat-treated at 150 degrees C (A15), but then significantly decreased as the heat treatment temperature increased (A20 and A25). The strength of the A15 composite was significantly higher than those of the other composites, and exceeded that (about 60 MPa) of the previous composite with no treatment. No significant difference was found in the flexural modulus of the composites.

Development of metal-resin composite restorative materia. Part 1. Experimental composite using silver-tin alloy as filler and 4-META as coupling agent

Metal-resin composites, using metal particles instead of inorganic particles as the filler and 4-META as the coupling agent, were experimentally prepared under 20 different conditions (five different concentrations of 4-META, and four different contents of metal particles). The flexural strength of the prepared metal-resin composites was in the range of about 14.5-61.3 MPa. The flexural strength was significantly influenced by the 4-META concentration, the metal particle content and their interaction. The highest strength was estimated at 2-3 mass% of 4-META concentration and 92.0-93.5 mass% metal filler content. The flexural modulus of the metal resin composite ranged approximately from 7.8 GPa to 15.5 GPa. The flexural modulus of the metal resin composite significantly increased with the metal particle content. The effect of the 4-META concentration on the flexural modulus was not significant.

Primary hepatic lymphoma in a patient with chronic hepatitis B

Primary hepatic lymphoma is a rare disorder and the clinical behavior remains unknown. We report a patient with primary hepatic lymphoma who had chronic hepatitis B. She was asymptomatic; however, a solitary tumor in the left lobe was incidentally detected. After left hepatic lobectomy was performed, a diagnosis of non-Hodgkin's lymphoma was made. No tumor was found except in the liver. Immunohistochemical stains for hepatitis B surface and core antigens were positive in hepatocytes; however, both were negative in the tumor tissue. The patient received no chemotherapy and the tumor relapsed. After chemotherapy, the tumor disappeared. However, exacerbation of hepatitis occurred after the fourth chemotherapy. The patient was followed up without chemotherapy, and she remains in apparent remission. Chemotherapy is effective against primary hepatic lymphoma and, if possible, patients with this disorder should be treated with chemotherapy postoperatively.

High levels of ferritin and its iron in fetal bovine serum

In 13 lots of the commercial fetal bovine sera, the ferritin levels ranged between 0.8 and 6.0 micrograms/ml. The serum ferritin iron concentration as measured by a quantitative immunoprecipitation technique ranged from 0.16 to 0.96 microgram/ml, and the iron content of ferritin was about 20% regardless of its protein concentration in sera. The percentage of ferritin iron to total serum iron ranged from 8.8 to 28.5%, and correlated significantly with ferritin concentration (r = 0.9368, P < 0.001). No significant proportion of the ferritin in fetal serum bound to concanavalin A. Immunoblotting showed that the molecular weights of L(iver)- and H(eart)-type subunits of fetal serum ferritin were identical to those of L and H subunits of adult bovine spleen ferritin (L:21kDa, H:18kDa), respectively, and that the L subunit predominated in the serum protein. Serum transferrin level was relatively constant (1.8-2.2 mg/ml), whereas transferrin saturation varied from 54.8 to 91.7%. There was a significant correlation between serum ferritin concentration and transferrin saturation (r = 0.8864, P < 0.001). These findings demonstrate that the bovine fetuses have the elevated iron stores.

Partially covered Gianturco stent for tracheobronchial stricture caused by intraluminal tumor

Partially covered Gianturco stents were used successfully in two patients to treat tracheobronchial strictures caused by intraluminal tumor growth. The stents were accurately placed without complications. The covered portion of the stent compressed the tumor, and prevented tumor ingrowth until the patients' deaths. This stent seems to act as effective palliation for tracheobronchial stricture caused by intraluminal tumor.

[Unilateral persistent hyperhidrosis after ischemic stroke]

A 64-year-old right hemiplegic woman, who had been treated for hypertension for 15 years, was admitted to our hospital. Neurologic examination on admission disclosed right hemiplegia and motor aphasia; however, ophthalmoparesis, pupillary abnormality, and blepharoptosis were not evident. Excessive sweating on the right side of the body, which was most marked on the face, was observed. Amount of sweating on the left side of the body was normal. Unilateral hyperhidrosis persisted for more than 2 months. MRI revealed hemorrhagic infarctions in the left basal ganglia, internal capsule, thalamus, hypothalamus, and medial part of the cerebral peduncle. 123I-IMP SPECT disclosed hypoperfusion in the left striatum, thalamus, occipital cortex, and right cerebellar hemisphere. Cerebral angiography revealed arteriosclerotic changes in the basilar artery, but that the left posterior cerebral artery and its branches were not occluded. Unilateral persistent hyperhidrosis is rare after ischemic stroke. Hypothalamic lesion was thought to be responsible for the hyperhidrosis in this patient. As the hypothalamus receives its blood supply from the posterior cerebral artery, unilateral persistent hyperhidrosis may be an important sign of cerebral infarction in the posterior cerebral artery region.

[Relationship between the total IgE levels and specific IgE antibodies]

In this study, nine allergens were selected; i.e. 1289 cases of d1, 1277 cases of e1, 1547 cases of f1, 1063 cases of t17 and others, for investigating the relationship between the total IgE level and RAST score. The results showed that the total IgE level was high in high d1 score, and 29 cases of low IgE level were observed in high f1 score groups. On the other hand, the comparison of the CAP system and the total IgE level showed. The result shows that one case of low total IgE value was found in highest d1 score group.

[Various kinds of glossiness of Au-Ag-Cu alloys with different surface finishes]

Nine experimental Au-Ag-Cu alloys with different surface finishes were measured for various kinds of glossiness using a digital variable gloss meter. Eight different methods of measurement for glossiness were chosen from the ones described in Japanese Industrial Standard Z 8741-1962. In addition to glossiness, color coordinates in the CIELAB color scale and surface roughness were measured. The compositions of the alloys were 40, 50, or 60 at% gold, 0, 20, or 40 at% copper, and 0-60 at% silver (balance). This study was initiated to collect fundamental data necessary to determine the most appropriate characteristic which could express the degree of tarnishing of various dental alloys independently of their own colors and compositions. Only one type of contrast glossiness based on two different receptor apertures with an incident angle of 60 degrees could demonstrate statistically significant differences between all the combinations of the different surface conditions analyzed. Effects of compositions on the values of various kinds of glossiness and color coordinates of the alloys with highly polished surfaces were statistically significant except contrast glossiness of different receptor apertures. Specular gloss and contrast gloss were considered to be as inappropriate as color of total reflected light in measuring the degree of tarnishing of dental alloys.

[Setting expansion of dental stone in hydrophilic addition type silicone impression]

The setting expansion of a dental stone poured in addition silicone impression materials was evaluated. Impressions were made of two different addition silicones (hydrophilic and hydrophobic) that had three different consistencies (injection, regular and putty). A dental stone which did not contain any additives was poured in the impressions and the setting expansion of the stone was automatically measured using an electric micrometer and a computer. The setting expansion of the stone that was poured in the impression did not significantly vary with the consistency of the silicones. On the other hand, the setting expansion of the stone in the hydrophilic silicone was significantly larger than that in hydrophobic silicone.

Chronic myelocytic leukemia probably promoted by growth hormone

The study shows clinical evidence that growth hormone (GH) presumably promoted Ph1-positive chronic myelocytic leukemia in a 14-year-old boy who was receiving GH treatment for growth failure after surgery and irradiation for craniopharyngioma. Leukocytosis associated with immature myelocytic cells and low leukocyte alkaline phosphatase score appeared one year after GH treatment. Cytogenic study showed the presence of Ph1 chromosome.

Effects of prostaglandin E1 infusion in the pre-operative management of critical congenital heart disease

Prostaglandin E1 (PGE1) was administered to 27 infants in whom pulmonary or systemic blood flow was entirely or significantly dependent upon the patency of the ductus arteriosus. In 12 patients with pulmonary atresia or severe pulmonary stenosis, PGE1 infusion was followed by an improvement in hypoxemia and acidemia (group I). In 2 patients with left ventricular outflow-tract obstruction, PGE1 infusion was followed by an improvement in arterial blood pressure, peripheral perfusion and urine output (group II). In 5 patients with d-transposition of the great arteries and intact ventricular septum who had persistent severe hypoxemia after creation of an interatrial communication, PGE1 infusion improved the arterial oxygenation with dilatation of the ductus arteriosus (group III). Seven patients (3 of group I, 2 of group II and 2 of group III) failed to respond to PGE1. There were no fatal side effects. It is concluded that PGE1 therapy is highly effective in stabilizing pre-operative conditions of infants with ductus-dependent congenital heart disease.

[Measurement of casting shrinkage with U-type tungsten die (author's transl)]

A simple method was developed for the accurate measurement of casting shrinkage using a U-type tungsten die. A wax pattern was prepared on the die and both were invested together in phosphate bonded investment. Cobalt-chromium alloy, Regalloy shot 2, was cast and its shrinkage was calculated from the distance of the gap created between the die and the cast piece. In order to evaluate the effects of some manipulative variables on the cast shrinkage value of the alloy, mold temperature, kind of liquid for the investment and powder/liquid ratio were varied and shrinkage values were obtained. The results showed that the shrinkage value was not affected by the kind of liquid and the power/liquid ratio, but significantly decreased as the mold temperature raised up to 600 degree C. However, this effect was eliminated by means of substractive correction of the thermal expansion of the tungsten die. Thus, the casting shrinkage of the cobalt-chromium alloy, Regalloy shot 2, was calculated to be 2.08 +/- 0.02%. The casting shrinkage of pure gold was also measured with the same procedure. The casting shrinkage was calculated to be 1.73 +/- 0.04% and highly consistent with the value (1.74%) reported by R. Earnshaw. This suggested that the developed method was sufficiently effective for the accurate measurement of casting shrinkage.