Spontaneous Regression of Blastic Plasmacytoid Dendritic Cell Neoplasm Following Sepsis by Serratia marcescens: A Case Report and Literature Review

Spontaneous regression is rare in patients with blastic plasmacytoid dendritic cell neoplasm (BPDCN). An 85-year-old man presented with pancytopenia and skin lesions, and the bone marrow exhibited 79.6% CD4+, CD56+, CD123+, and TCL-1+ abnormal cells, with a normal karyotype; he was thus diagnosed with BPDCN. While being followed without chemotherapy, he was admitted due to sepsis induced by Serratia marcescens, which was successfully treated with antibiotics. Notably, his blood cell counts improved, and the skin lesions disappeared. To our knowledge, this is the first reported case of spontaneous regression of BPDCN with a decrease in tumor cells in the bone marrow following sepsis.

A case of TAFRO syndrome, a variant of multicentric Castleman's disease, successfully treated with corticosteroid and cyclosporine A

We report a case of a 46-year-old woman with fever, pleural effusion, massive ascites, severe edema, hepatosplenomegaly, elevation of serum creatinine level, proteinuria, and severe thrombocytopenia. Her clinical features were compatible with TAFRO syndrome proposed as a variant of multicentric Castleman's disease, that is occasionally associated with poor prognosis. Treatment with corticosteroid improved her symptoms partially. However, thrombocytopenia, ascites, and edema persisted. The use of cyclosporine A successfully improved her condition, resulting in remission.

A novel autoantibody against fibronectin leucine-rich transmembrane protein 2 expressed on the endothelial cell surface identified by retroviral vector system in systemic lupus erythematosus

Introduction

Anti-endothelial cell antibodies (AECAs) are thought to be critical for vasculitides in collagen diseases, but most were directed against molecules localized within the cell and not expressed on the cell surface. To clarify the pathogenic roles of AECAs, we constructed a retroviral vector system for identification of autoantigens expressed on the endothelial cell surface.

Methods

AECA activity in sera from patients with collagen diseases was measured with flow cytometry by using human umbilical vein endothelial cells (HUVECs). A cDNA library of HUVECs was retrovirally transfected into a rat myeloma cell line, from which AECA-positive clones were sorted with flow cytometry. cDNA of the cells was analyzed to identify an autoantigen, and then the clinical characteristics and the functional significance of the autoantibody were evaluated.

Results

Two distinct AECA-positive clones were isolated by using serum immunoglobulin G (IgG) from a patient with systemic lupus erythematosus (SLE). Both clones were identical to cDNA of fibronectin leucine-rich transmembrane protein 2 (FLRT2). HUVECs expressed FLRT2 and the prototype AECA IgG bound specifically to FLRT2-transfected cells. Anti-FLRT2 antibody activity accounted for 21.4% of AECAs in SLE. Furthermore, anti-FLRT2 antibody induced complement-dependent cytotoxicity against FLRT2-expressing cells.

Conclusions

We identified the membrane protein FLRT2 as a novel autoantigen of AECAs in SLE patients by using the retroviral vector system. Anti-FLRT2 antibody has the potential to induce direct endothelial cell cytotoxicity in about 10% of SLE patients and could be a novel molecular target for intervention. Identification of such a cell-surface target for AECAs may reveal a comprehensive mechanism of vascular injury in collagen diseases.

Thrombotic microangiopathy presenting with a considerable accumulation of ascites: a case report

A 46-year-old man presented with fever, thrombocytopenia, and a considerable accumulation of ascites. Although prednisolone and intravenous cyclophosphamide pulse (IVCY) were effective, he experienced recurrence. Renal insufficiency and hemolytic anemia developed subsequently. Schistocytes, negative Coombs' test, and elevated lactate dehydrogenase levels indicated thrombotic microangiopathy (TMA). He recovered well after receiving plasma infusion, IVCY, and prednisolone. Renal biopsy revealed subendothelial widening, thereby confirming TMA. This is a very rare case of TMA that presented with a considerable volume of ascites.

The use of tacrolimus for recurrent lupus enteritis: a case report

Introduction

Patients with lupus enteritis sometimes experience recurrence. In such cases, the addition of cyclophosphamide to the treatment regimen is recommended. However, an appropriate treatment has not been established in cases where cyclophosphamide failed to prevent the disease.

Case presentation

An 18-year-old Japanese woman was admitted for a recurrence of lupus enteritis. One year before admission she was treated for lupus enteritis with high-dose corticosteroid together with intravenous cyclophosphamide pulse therapy. Upon admission, she was administered again with high-dose corticosteroid and her abdominal pain rapidly subsided. Tacrolimus was later used as an immunosuppressive agent and a complete remission has been maintained.

Conclusion

Tacrolimus can be a useful agent for recurrent lupus enteritis that is resistant to conventional therapy.

Pregnancy-associated thrombotic thrombocytopenic purpura with anti-centromere antibody-positive Raynaud's syndrome

Thrombotic thrombocytopenic purpura (TTP), scleroderma renal crisis (SRC), and hemolysis, elevated liver enzyme levels, and a low platelet count (HELLP) syndrome display common symptoms that include microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. Therefore, it is important to distinguish between them because their treatments vary: however, the differential diagnosis is sometimes difficult. We report a 32-year-old woman who was referred to our department for further examination of microangiopathic hemolytic anemia, thrombocytopenia, and a slightly elevated serum creatinine level with anti-centromere antibody-positive Raynaud's syndrome in the early puerperal period. TTP, SRC, and HELLP syndrome were considered in the differential diagnosis, but the measurement of a disintegrin-like metalloprotease with thrombospondin type 1 motifs 13 (ADAMTS 13) activity and its inhibitor level led to the diagnosis of TTP. She was successfully treated by plasma exchange and high-dose prednisolone and angiotensin-converting enzyme inhibitor. If microangiopathic hemolytic anemia and thrombocytopenia are observed in perinatal women or patients with signs of systemic sclerosis, the measurement of ADAMTS13 activity and its inhibitor level are essential for diagnosis and therapeutic choice.

Peripheral T cell lymphoma with a high titer of proteinase-3-antineutrophil cytoplasmic antibodies that resembled Wegener's granulomatosis

Here, we present a 54-year-old man with proptosis and swelling below the left eyelid. Laboratory findings showed high levels of PR3-ANCA and histological examination of the first biopsy revealed acute inflammation. Together with the findings of MRI, a diagnosis of WG was made. However, the disease progressed rapidly and histological examination of the second biopsy revealed infiltration of neoplastic T lymphocytes with aberrant loss of CD7. A final diagnosis of peripheral T cell lymphoma, not otherwise specified (WHO) was made, and complete remission was achieved by chemotherapy. This is a very rare case of T cell lymphoma with a high titer of PR3-ANCA.

Human Parvovirus B19 Transgenic Mice Become Susceptible to Polyarthritis

Human parvovirus B19 (B19) often causes acute polyarthritis in adults. In this paper, we analyzed nucleotide sequences of the B19 genome of patients with rheumatoid arthritis (RA), and then introduced the nonstructural protein 1 (NS1) gene of B19 into C57BL/6 mice that had a genetic origin not susceptible to arthritis. The transgenic mice developed no lesions spontaneously, but were susceptible to type II collagen (CII)-induced arthritis. B19 NS1 was expressed in synovial cells on the articular lesions that were histologically characteristic of granulomatous synovitis and pannus formation in cartilage and bone. Serum levels of anti-CII Abs and TNF-alpha increased in NS1 transgenic mice to the same levels as those of DBA/1 mice, which were susceptible to polyarthritis. Stimulation with CII increased secretion of Th1-type- and Th2-type cytokines in NS1 transgenic mice, indicating that a nonpermissive H-2(b) haplotype in the wild type of C57BL/6 mice can be made susceptible to polyarthritis through the expression of NS1. This study is the first to show that a viral agent from the joints in humans can cause CII-induced arthritis resembling RA.

SS-A/Ro52, an autoantigen involved in CD28-mediated IL-2 production

An autoantibody against SS-A/Ro52 (Ro52) is most frequently found in the sera of patients with Sjögren's syndrome, systemic lupus erythematosus, and congenital heart block from anti-Ro52 Ab-positive mother. However, the physiological function of the autoantigen SS-A/Ro52 has not yet been elucidated. In this study, we describe the role of Ro52 protein in T cell activation. Overexpression of SS-A/Ro52 in Jurkat T cell resulted in enhanced IL-2 production following CD28 stimulation. Furthermore, transfection of anti-Ro52-specific small RNA duplexes partially blocked the expression of native and overexpressed Ro52 in Jurkat T cell, resulting in decreased IL-2 production via CD28 pathway in these cells. Finally, intracellular localization of Ro52 dramatically changed following CD28 stimulation. Our data reveal a novel function of Ro52 in CD28-mediated pathway, which eventually contributes to cytokine production and expression of the T cell biological programs.

CD26-mediated signaling for T cell activation occurs in lipid rafts through its association with CD45RO

CD26 is a T cell activation antigen that contains dipeptidyl peptidase IV activity and is known to bind adenosine deaminase. The mechanism by which CD26 costimulation potentiates T cell receptor-mediated T cell activation, leading to subsequent exertion of T cell effector function, is still not clearly defined. In this article, we demonstrate that CD26 localizes into lipid rafts, and targeting of CD26 to rafts is necessary for signaling events through CD26. Importantly, aggregation of CD26 by anti-CD26 mAb crosslinking also causes coaggregation of CD45 into rafts. Moreover, we show that CD26 directly binds to the cytoplasmic domain of CD45. Our results therefore indicate a mechanism whereby CD26 engagement promotes aggregation of lipid rafts and facilitates colocalization of CD45 to T cell receptor signaling molecules p56(Lck), ZAP-70, and TCRzeta, thereby enhancing protein tyrosine phosphorylation of various signaling molecules and subsequent interleukin-2 production.

Error-related brain potentials elicited by vocal errors

Error-related negativity (ERN) is observed immediately after an error in choice reaction time tasks performed by hand response. We examined whether the ERN occurs in relation to slips of vocalization in the Stroop color word task. In one condition, the subject's vocal responses were masked by continuous pink noise in order to prevent vocalization-related cortical potentials from contaminating the ERN time window. This masking procedure was successful in inhibiting the vocalization-related cortical potential. More importantly, vocalization errors elicited a frontocentral negative-going deflection followed by a positive component immediately after the error response regardless of the masking condition. The present results suggest that the error detection mechanism may also elicit an ERN-like component in response to vocal slips.

Decreased expression of transcription factor GATA-2 in haematopoietic stem cells in patients with aplastic anaemia

Aplastic anaemia is characterized by reduced haematopoiesis resulting in pancytopenia. It has been speculated that there is an injury in haematopoietic stem cells in the bone marrow; however, the precise nature of the injury has not been elucidated. In this study, the levels of expression of mRNAs for three transcription factors, GATA-2, SCL and AML1, which function in the early stages of haematopoiesis, were examined by quantitative polymerase chain reaction in patients with aplastic anaemia, idiopathic thrombocytopenic purpura (ITP) and normal subjects. Among these factors, expression of GATA-2 mRNA in purified CD34-positive cells was markedly decreased in aplastic anaemia compared with that in ITP and in normal subjects. The expression levels of SCL and AML1 mRNA in CD34-positive cells in aplastic anaemia were not different from those in normal subjects. When the expression of GATA-2 protein in CD34-positive cells was examined by immunocytochemical analysis, the percentage of GATA-2-positive cells in aplastic anaemia was lower than that in normal subjects. These findings strongly suggest that there is an aberrant expression of transcription factors in stem cells in aplastic anaemia, which may be responsible for the development of the disease.

Expression of gp34 (OX40 ligand) and OX40 on human T cell clones

gp34, which we previously cloned, is a ligand of OX40 (CD134), a costimulatory molecule involved in T cell activation. To elucidate the role of human OX40 / OX40L interaction, we examined the expression of gp34 (OX40L) and OX40 in normal human hematopoietic cells by using flow cytometry. OX40 expression is observed on activated T cells, while OX40L is expressed in antigen-presenting cells. However, cytotoxic T lymphocyte (CTL) clones specific for Epstein-Barr virus (EBV)-transformed autologous lymphoblastic cell lines (LCLs) induced both OX40 and OX40L expression after antigen or T cell receptor (TCR) stimulation. This study suggests a possible function of OX40L / OX40, through T cell-T cell interaction, in the reactivation of memory T cells in an autocrine manner, with implications for the pathogenesis of viral infections and neoplasms.

A repressor element in the 5'-untranslated region of human Pax5 exon 1A

B-cell-specific activator protein (BSAP) encoded by the Pax5 gene plays a critical role during B-cell development. We have analyzed the 5'-flanking region plus the 5'-untranslated region (5'-UTR) of human Pax5 exon1A to clarify its regulatory mechanisms. Functional dissection of these regions by luciferase reporter assays indicated that a cluster of regulatory elements acts as a strong repressor between +320 and +453. Insertion of this segment between the heterologous simian virus 40 (SV40) promoter and the luciferase gene in both the sense and reverse orientation sharply reduced the luciferase activity, but insertion into the upstream of the SV40 promoter did not. This suggests that this segment must be located in the 5'-UTR to function effectively. A search through databases with the sequence of this segment did not reveal any known DNA binding factor site. Electrophoretic gel mobility shift assay (EMSA) experiments demonstrated that unknown factors bound to the fragment +408 to +429. Insertion of this fragment between the SV40 promoter and the reporter gene strongly suppressed the luciferase activity. Competitive EMSA indicated that the region between nucleotides +413 and +427 encompassed the binding site of the unknown factors and was hence regarded as a repressor element. Mutagenesis in this element significantly recovered reporter gene activity. These results suggest that the segment +320 to +453, especially the repressor element +413 to +427, in the 5'-UTR is involved in the regulation of Pax5 gene expression.

Chemically modified ribozyme to V gene inhibits anti-DNA production and the formation of immune deposits caused by lupus lymphocytes

A variety of autoantibodies is responsible for the tissue injury in autoimmune diseases. We have demonstrated that the human anti-DNA Ab O-81, of which Ids are commonly detected in renal glomeruli of active lupus nephritis, uses the V3-7 gene. We tried to develop a new therapy for lupus nephritis by using chemically modified ribozymes to specifically inhibit the expression of the mRNA of Ig V gene. The transfection of hammerhead ribozyme or the addition of chemically modified ribozyme against the flanking region of V3-7 caused a potent and selective inhibition of anti-DNA production in V3-7-using B cell clones, but not in irrelevant V gene-using clones in vitro. Chemically modified ribozyme was long-acting and resistant to RNase, and nonspecific cytotoxicity of the ribozyme was negligible. To know the efficacy of the ribozyme in vivo, we used a model of immune complex nephritis in SCID mice in which 5 x 10(6) PBLs from patients with active lupus nephritis (lupus PBL) were transferred twice. The injection of lupus PBL in combination with chemically modified ribozyme to increase resistance to RNase significantly reduced anti-DNA Ab levels in blood and decreased levels of urinary protein in the immune deposit models. Immunofluorescence study also revealed a marked decrease in IgG deposits at renal glomeruli in the ribozyme-treated group. These results indicate an efficacy of chemically modified ribozyme therapy for autoantibody-mediated immune diseases.

An electrophysiological study of the locus of the interference effect in a stimulus-response compatibility paradigm

This study investigated the locus of the interference effect in a stimulus-response compatibility task using event-related potentials (ERPs). Ten participants were instructed to respond to stimulus color with the left or right middle finger. Red or blue arrows pointed in the same direction as the response hand on congruent trials and pointed in the opposite direction on incongruent trials. Neutral trials were red or blue horizontal bars. Reaction times (RTs) to incongruent stimuli were significantly longer than RTs to congruent stimuli. The peak latency of the P300 for incongruent stimuli was significantly longer than that for congruent stimuli. In addition, onset of stimulus-locked lateralized readiness potential (LRPs) was significantly later for incongruent stimuli than for congruent stimuli. However, electromyogram (EMG)-locked LRPs for incongruent stimuli showed incorrect preparation. These results suggest that the interference effect might occur at the stage in which stimulus evaluation processes and response-related processes overlap.

Human movement-related brain potentials preceding voluntary movements in different arousal states monitored with skin potential level

The present study investigated the readiness potential (RP) preceding a brisk extension of the right middle finger during different arousal states as monitored by skin potential level (SPL). The late component of the readiness potential in the medium arousal state was significantly larger than those in the low and high arousal states. This finding indicates that the RP waveform may vary as a function of arousal states, suggesting the inverse U-shaped relationship proposed in studies of the contingent negative variation.

Enhanced negative slope of the readiness potential preceding a target force production task

Readiness potentials (RPs) preceding a trigger pulling movement were recorded in 9 right-handed male subjects. We investigated two tasks, non-purposive and purposive movement tasks. In this study we defined simple trigger pull as non-purposive, and target force production by pulling the trigger as purposive. In the non-purposive task, the subjects were instructed to pull the trigger at their own pace and at an easily-exerted force level. After two sessions in the non-purposive movement task, the subjects were submitted to the purposive movement task, and were requested to pull the trigger in an attempt to produce target force, the range of which was decided individually on the basis of mean force level in the second session of the non-purposive movement task. The RP preceding the purposive movement was larger than that preceding the non-purposive movement. In addition, enhancement of the RP was specific to the negative slope (NS'). Since neither peak force nor time to peak force of the movement differed in the two tasks, it was concluded that the increased NS' was due to a psychological change associated with execution of the purposive movement.

HTLV-I Tax trans-activation and cell growth signaling

We have cloned two genes for cell surface molecules, capable of delivering the intracellular signals, which are modulated for their expression by Tax. One is the gamma chain of the interleukin-2 (IL-2) receptor which is suggested to be critical for IL-2-dependent growth of human T-cell leukemia virus type I (HTLV-I) infected cells. The gamma chain is upregulated by Tax, like the IL-2 receptor alpha chain. This upregulation may compensate the gamma chain downregulation after IL-2 binding, presumably resulting in more frequent growth of HTLV-I infected T cells. The other is gp34 that was initially identified as a molecule specifically expressed on HTLV-I-infected T cells. gp34 has been demonstrated to bind OX40 which belongs to the tumor necrosis factor (TNF) receptor family. We found that HTLV-I Tax induces expression of gp34 and OX40, and that normal T cell transiently express both gp34 and OX40 upon antigenic stimulation. Collectively, it may be possible that HTLV-I-infected T cells are in a predisposition to growth due to modulated expression by HTLV-I Tax of gp34/OX40 and the gamma chain.

Selective inhibition of the mouse brain Mn-SOD by methylmercury

Changes in mRNA levels, protein contents and enzyme activities for brain Cu,Zn- and Mn-SOD by methylmercury chloride (MMC) administration, were examined, over a period of 12 days in ICR male mice. After subcutaneous administration of MMC (10 mg/kg) to mice, brain mercury content reached a maximum at 2 days and remained at that level for at least 5 days. MMC exposure resulted in a time-dependent decrease in the Mn-SOD activity: the enzyme activity at 5 days after exposure to MMC was about 60% of control level whereas this exposure was without effect on the Cu,Zn-SOD activity, indicating differential sensitivity of SOD isozymes to the metal. However, levels of mRNA and protein synthesis for Mn-SOD were unaffected by MMC administration. The direct effect of MMC on the both SOD activities were further examined with purified enzyme preparations. After each SOD isozyme (10 U) was incubated with 0.2 mM MMC for 24 h at pH 7.8, the enzyme activities for Cu,Zn- and Mn-SOD were 90% and 37% of control, respectively. Incubations at a ratio of SOD to MMC (1 : 600) for 24 h resulted in a substantial decrease in the enzyme activity of the Mn form; this isozyme-selective inactivation was noted at alkaline pH. A combination of isoelectric focusing-agarose gel electrophoresis (IEF-AGE) and synchrotron radiation X-ray fluorescence (SR-XRF) analysis revealed that Mn-SOD rather than Cu,Zn-SOD underwent modification. Furthermore, a decrease in native form of Mn-SOD protein after MMC exposure was confirmed by gel filtration chromatography. These results indicate that Mn-SOD, but not Cu,Zn-SOD, is susceptible to modification by MMC and the resulting alteration in structure appears to cause a loss of enzyme activities.

Isozyme selective induction of mouse pulmonary superoxide dismutase by the exposure to mercury vapor

Alterations in lung superoxide dismutase (SOD) isozymes after exposure of mice to mercury vapor were examined. Inhalation of mercury vapor (10 mg/m(3)) for 1 h by mice resulted in a higher accumulation of mercury in the kidney and lung compared to other organs, at 1 h after exposure. Under these conditions marked enhancement of protein content in bronchoalveolar fluid (BALF), attributed to lung injury, was observed. Exposure to mercury vapor caused a significant increase in the pulmonary Cu,Zn-SOD activity (1.32-fold at 48 h) whereas Mn-SOD activity was suppressed to 82% of the control level, suggesting different sensitivity to the metal inhalation. The selective induction of Cu,Zn-SOD protein (1.79-fold at 48 h) was confirmed by immunoblot analysis with polyclonal antibodies against these isozymes. These observations suggest that the selective induction of Cu,Zn-SOD at the translational level appears to occur as an initial defense against mercury-promoted oxidative stress.

Induction of OX40, a receptor of gp34, on T cells by trans-acting transcriptional activator, Tax, of human T-cell leukemia virus type I

gp34, which we had identified as a target molecule of the trans-activation by Tax of human T-cell leukemia virus type I (HTLV-I), has been found to bind OX40, a member of the tumor necrosis factor receptor family, resulting in growth stimulation of activated T cells. We here demonstrate that not only gp34 (OX40L), but also OX40 can be transcriptionally activated by Tax. Three Tax-producing human T-cell lines carrying the HTLV-I genome expressed OX40 on their surfaces. Furthermore, Tax-induced transcriptional activation of OX40 was shown in Tax-inducible JPX-9 cells. These results demonstrate that both OX40 and its ligand (gp34) are constitutively expressed on the surfaces of Tax-expressing T lymphocytes, suggesting that the OX40L/OX40 system contributes to growth stimulation of the virus-infected T cells.

Functional analysis of the human interleukin 2 receptor gamma chain gene promoter

The third component of the interleukin (IL) 2 receptor, gamma chain, is essential not only for IL-2- but also for IL-4-, IL-7-, IL-9-, and IL-15-induced proliferation of lymphocytes. To elucidate the mechanisms by which the gamma chain is expressed, we have analyzed the promoter region of the gamma chain gene. The 633-base pair fragment upstream of the initiation codon showed the promoter activity in human hematopoietic cell lines, Jurkat and THP-1, when linked to the luciferase gene. With a series of 5'-deletion mutants, the basal promoter activity was found in a fragment from nucleotide 80 to 58 upstream from the RNA start site, including an Ets binding sequence. Treatment of cells with either 12-O-tetradecanoylphorbol-13-acetate or phytohemagglutinin but not forskolin induced transcription from the gamma chain gene promoter. A viral trans-acting transcriptional activator, Tax, of human T-cell leukemia virus type I elevated expression of the gamma chain gene. In contrast, IL-2 decreased transcription from the IL-2 receptor gamma chain promoter. These results suggest that expression of the gamma chain is regulated at the transcription level by extracellular stimuli and may be implicated in immune response.

Compressed heart and mitral valve prolapse in a case of Duchenne's progressive muscular dystrophy with thorax deformity

We report on a 15 year old patient with Duchenne's progressive muscular dystrophy who demonstrated a narrowing of the left ventricular inflow and outflow tracts due to compression by a highly deformed thoracic spine. A systolic murmur (4/6) with thrill and a diastolic murmur (2/6) were heard, with these murmurs being louder in the expiratory phase as compared with the inspiratory phase. The second heart sound showed a paradoxical splitting. Echocardiograms revealed a compressed and narrowed left ventricle and a prolapsed mitral valve. The intensities of the heart murmurs changed synchronously with the chamber's narrowing due to respiration. A narrowed left ventricle occurring as a result of the compression by the deformed thoracic spine is thought to be the cause of these cardiac findings.

Ultrastructural studies on the neuromuscular junctions of Becker's muscular dystrophy

Ultrastructural studies on muscle biopsies from three patients with Becker's muscular dystrophy showed that the i.m. nerves presented loss or disarrangement of the neurofilaments and an increased number of glycogen granules and/or myelin figures not infrequently in the myelinated and unmyelinated nerve fibers. The neuromuscular junctions showed markedly widened sole-plate areas, and several terminal axons frequently abutted and formed neuromuscular junctions on the same fiber. The secondary synaptic clefts were markedly decreased in number and short in length in type I fibers but not in type II fibers. Most terminal axons showed no degenerative changes. Therefore, the participation of a neural factor might be suggested as the cause of Becker's muscular dystrophy, although it does not mean denervation in the conventional sense of an axonal degeneration.

The causative mechanisms of mitral valve prolapse in progressive muscular dystrophy in reference to thorax and thoracic spine deformities and left ventricular dysfunction

The causative mechanisms of mitral valve prolapse (MVP) were evaluated in 58 patients with progressive muscular dystrophy (PMD). Two possible causes, 1) left ventricular (LV) dysfunction and 2) thoracic spine and thorax deformities were assessed. Patients were classified into three groups by echocardiographic findings. Group 1: 31 patients without MVP, group 2: 11 patients with MVP confirmed only by M-mode echocardiogram, group 3: 16 patients with MVP confirmed by both two-dimensional and M-mode echocardiograms. LV functions evaluated by systolic time intervals and fractional shortening showed no significant differences among the three groups. Scoliosis of the thoracic spine was not related to the incidence of MVP. Lordotic or straight spines were found in 32.3%, 100%, 93.8% of cases in group 1, group 2 and group 3, respectively, and the incidences of MVP in cases with kyphosis, straight spine and lordosis were 4.8%, 66.7% and 77.8%, respectively. The shape of the thorax as evaluated by the ratio of anteroposterior internal diameter to transverse diameter was more flattened in groups 2 and 3 than in group 1. From these results, we concluded that LV dysfunction was not related to the incidence of MVP and that the lordotic or straight spine and the flattened thorax were supposed to be the major factors in the occurrence of MVP in PMD.

[Spectral analysis of finger photoelectric plethysmogram in its relation to emotion: visual display of baseline deflection and pulse wave]

The present study applied spectral analysis of finger photoelectric plethysmogram (PTG) to describe the emotional factor involved in baseline deflection of PTG. Using 23 normal male students as subjects, PTG was measured under rest, verbal instruction, and electric shock conditions. PTG spectral analysis via fast Fourier transform was carried out on the consecutive 10 X 9 ms X 1 024 points X 4(398.64 s) samples in each condition with frequency resolution at 0.0109 Hz. In the analysis of power spectra, two distinct power peaks were observed in all conditions; below 0.3 Hz and around 1.0 Hz. It was confirmed that the former was baseline deflection and the latter was heart beat component. There were no differences in each peak frequency among conditions. Whereas peak power below 0.3 Hz tended to increase all through verbal instruction and electric shock conditions as compared to rest one. These results were discussed in relation to anxiety involved in emotion.

[Regional wall motion of the left ventricle in congestive cardiomyopathy: in comparison with progressive muscular dystrophy of Duchenne type (author's transl)]

The features of regional wall motion abnormalities of the left ventricle were analysed in 11 patients of congestive cardiomyopathy (CCM) in comparison with 22 patients of progressive muscular dystrophy (DMD) of Duchenne type who showed an abnormal motion of the left ventricle by echocardiography. Real time two-dimensional echocardiographic study demonstrated the following results: I) In CCM, (1) only 2 or less of 11 cases preserved a normal motion in each left ventricular segment, and the depression of wall motion of the left ventricle were thought to be generalized; (2) there were 9 cases with segmental wall motion abnormalities and 3 of them demonstrated ventricular aneurysms, and (3) the localizations of the segmental abnormalities varied in each case, and there was no apparent accumulation to any segments. II) In DMD, (1) all the cases showed depressed motions and 8 of them demonstrated a ventricular aneurysm in the posterior wall of the left ventricle (LVPW), (2) while, there was no case showing ventricular aneurysm in the segments other than LVPW, and about one third of all cases showed normal motion in those segments. From these results, we concluded as follows: 1) Although the depression of a wall motion of the left ventricle was generalized in CCM, this was not always uniform and the segmental abnormalities of a wall motion were frequently observed. The localization of the most severely disturbed segment varied in each case. 2) On the other hand, in DMD, the wall motion was disturbed more frequently and more severely in LVPW than in other ventricular segments.

Nemaline myopathy: histological, histochemical and ultrastructural studies

Histological, histochemical and ultrastructural studies were performed on muscle biopsies from three siblings with congenital nemaline myopathy. Histological studies revealed type I fibre atrophy and type II fibre paucity. Ultrastructural studies of intramuscular nerves showed that the axonal diameters were very narrow compared with the width of myelin lamellae. Granular or membranous osmiophilic material occurred in the adaxonal Schwann cell cytoplasm and had a periodicity of 33--38 A. The neuromuscular junctions showed degenerative features such as glycogen granules or myelin figures in 27.1% of total terminal axons. The secondary synaptic clefts were markedly decreased in number and short in length. Myotendinous junction-like structures were found in 5.5% of the muscle fibres near the neuromuscular junctions, and often near sites of fibre-splitting. Rods in nemaline myopathy might be caused as a result of longitudinal splitting and disruption of fibres due to deficient regeneration of the muscle fibres associated with neurotrophic abnormalities.