Regression of venous thrombus after trans-sphenoidal hypophysectomy for pituitary-dependent hyperadrenocorticism in a dog

An 8.0-kg 8-year-old male dachshund was presented for surgical treatment of suspected pituitary-dependent hyperadrenocorticism with portal vein thrombosis. Advanced diagnostic imaging revealed a thrombus in the splenic and portal veins. For the portal vein thrombus, CT angiography showed an enhanced timing delay in the lateral right and caudate liver lobes. Blood tests showed a marked increase in the liver panel, including total bile acid. Brain MRI revealed a pituitary mass, suggesting pituitary-dependent hyperadrenocorticism. The mass was completely resected. The preoperative antithrombotic therapy of rivaroxaban (0.66 mg/kg, PO, once per day) and clopidogrel sulphate (1.66 mg/kg, PO, once per day) was continued postoperatively. Six months after resection of the pituitary mass, the thrombus had disappeared. Further studies are required to prove a causal association between the disappearance of the thrombus and the treatments provided.

Evaluation of reduction efficiencies of pepper mild mottle virus and human enteric viruses in full-scale drinking water treatment plants employing coagulation-sedimentation-rapid sand filtration or coagulation-microfiltration

Here, we evaluated the reduction efficiencies of indigenous pepper mild mottle virus (PMMoV, a potential surrogate for human enteric viruses to assess virus removal by coagulation-sedimentation-rapid sand filtration [CS-RSF] and coagulation-microfiltration [C-MF]) and representative human enteric viruses in four full-scale drinking water treatment plants that use CS-RSF (Plants A and B) or C-MF (Plants C and D). First, we developed a virus concentration method by using an electropositive filter and a tangential-flow ultrafiltration membrane to effectively concentrate and recover PMMoV from large volumes of water: the recovery rates of PMMoV were 100% when 100-L samples of PMMoV-spiked dechlorinated tap water were concentrated to 20 mL; even when spiked water volume was 2000 L, recovery rates of >30% were maintained. The concentrations of indigenous PMMoV in raw and treated water samples determined by using this method were always above the quantification limit of the real-time polymerase chain reaction assay. We therefore were able to determine its reduction ratios: 0.9-2.7-log10 in full-scale CS-RSF and 0.7-2.9-log10 in full-scale C-MF. The PMMoV reduction ratios in C-MF at Plant C (1.0 ± 0.3-log10) were lower than those in CS-RSF at Plants A (1.7 ± 0.5-log10) and B (1.4 ± 0.7-log10), despite the higher ability of MF for particle separation in comparison with RSF owing to the small pore size in MF. Lab-scale virus-spiking C-MF experiments that mimicked full-scale C-MF revealed that a low dosage of coagulant (polyaluminum chloride [PACl]) applied in C-MF, which is determined mainly from the viewpoint of preventing membrane fouling, probably led to the low reduction ratios of PMMoV in C-MF. This implies that high virus reduction ratios (>4-log10) achieved in previous lab-scale virus-spiking C-MF studies are not necessarily achieved in full-scale C-MF. The PMMoV reduction ratios in C-MF at Plant D (2.2 ± 0.6-log10) were higher than those at Plant C, despite similar coagulant dosages. In lab-scale C-MF, the PMMoV reduction ratios increased from 1-log10 (with PACl [basicity 1.5], as at Plant C) to 2-4-log10 (with high-basicity PACl [basicity 2.1], as at Plant D), suggesting that the use of high-basicity PACl probably resulted in higher reduction ratios of PMMoV at Plant D than at Plant C. Finally, we compared the reduction ratios of indigenous PMMoV and representative human enteric viruses in full-scale CS-RSF and C-MF. At Plant D, the concentrations of human norovirus genogroup II (HuNoV GII) in raw water were sometimes above the quantification limit; however, whether its reduction ratios in C-MF were higher than those of PMMoV could not be judged since reduction ratios were >1.4-log10 for HuNoV GII and 2.3-2.9-log10 for PMMoV. At Plant B, the concentrations of enteroviruses (EVs) and HuNoV GII in raw water were above the quantification limit on one occasion, and the reduction ratios of EVs (>1.2-log10) and HuNoV GII (>1.5-log10) in CS-RSF were higher than that of PMMoV (0.9-log10). This finding supports the usefulness of PMMoV as a potential surrogate for human enteric viruses to assess virus removal by CS-RSF.

Deep learning enables the automation of grading histological tissue engineered cartilage images for quality control standardization

OBJECTIVE

To automate the grading of histological images of engineered cartilage tissues using deep learning.

METHODS

Cartilaginous tissues were engineered from various cell sources. Safranin O and fast green stained histological images of the tissues were graded for chondrogenic quality according to the Modified Bern Score, which ranks images on a scale from zero to six according to the intensity of staining and cell morphology. The whole images were tiled, and the tiles were graded by two experts and grouped into four categories with the following grades: 0, 1-2, 3-4, and 5-6. Deep learning was used to train models to classify images into these histological score groups. Finally, the tile grades per donor were averaged. The root mean square errors (RMSEs) were calculated between each user and the model.

RESULTS

Transfer learning using a pretrained DenseNet model was selected. The RMSEs of the model predictions and 95% confidence intervals were 0.49 (0.37, 0.61) and 0.78 (0.57, 0.99) for each user, which was in the same range as the inter-user RMSE of 0.71 (0.51, 0.93).

CONCLUSION

Using supervised deep learning, we could automate the scoring of histological images of engineered cartilage and achieve results with errors comparable to inter-user error. Thus, the model could enable the automation and standardization of assessments currently used for experimental studies as well as release criteria that ensure the quality of manufactured clinical grafts and compliance with regulatory requirements.

Cell line-dependent difference in glutathione levels affects the cigarette sidestream smoke-induced inhibition of nucleotide excision repair

We recently reported that cigarette sidestream smoke (CSS) induced inhibition of nucleotide excision repair (NER) and the cause was NER molecule degradation by aldehydes contained in CSS [Carcinogenesis39, 56-65, 2018; Mutat. Res.834, 42-50, 2018]. In this study, we examined the relationship between intracellular glutathione (GSH) levels and CSS-induced NER inhibition. CSS treatment decreased the intracellular GSH level in human keratinocytes HaCaT, in which the repair of pyrimidine (6-4) pyrimidone photoproducts (6-4PPs) after UVB irradiation was suppressed. We used l-buthionine-(S,R)-sulfoximine (BSO) to artificially deplete intracellular GSH level. BSO treatment remarkably accelerated the CSS-induced NER inhibition. The NER inhibition by CSS was attributed to the delay of accumulation of NER molecules (TFIIH and XPG) to DNA damaged sites, which was further enhanced by BSO treatment. CSS degraded TFIIH, and BSO promoted it as expected. Formaldehyde (FA), a major constituent of CSS, showed similar intracellular GSH reduction and NER inhibition, and BSO promoted its inhibitory effect. Five cultured cell lines showed considerable variability in intrinsic GSH levels, and CSS-induced NER inhibitory effect was significantly correlated with the GSH levels. Chemicals like aldehydes are known to react not only with proteins but also with DNA, causing DNA lesions targeted by NER. Our results suggest that the tissues and cells with low intrinsic GSH levels are susceptible to treatment with CSS and electrophilic compounds like aldehydes through NER inhibition, thus leading to higher genotoxicity and carcinogenicity.

A Horizon Scan of research priorities to inform policies aimed at reducing the harm of plastic pollution to biota

Plastic pollution in the oceans is a priority environmental issue. The recent increase in research on the topic, coupled with growing public awareness, has catalyzed policymakers around the world to identify and implement solutions that minimize the harm caused by plastic pollution. To aid and coordinate these efforts, we surveyed experts with scientific experience identified through their peer-reviewed publications. We asked experts about the most pressing research questions relating to how biota interact with plastic pollution that in turn can inform policy decisions and research agendas to best contribute to understanding and reducing the harm of plastic pollution to biota. We used a modified Horizon Scan method that first used a subgroup of experts to generate 46 research questions on aquatic biota and plastics, and then conducted an online survey of researchers globally to prioritize questions in terms of their importance to inform policy development. One hundred and fifteen experts from 29 countries ranked research questions in six themes. The questions were ranked by urgency, indicating which research should be addressed immediately, which can be addressed later, and which are of limited relevance to inform action on plastics as an environmental pollutant. We found that questions relating to the following four themes were the most commonly top-ranked research priorities: (i) sources, circulation and distribution of plastics, (ii) type of harm from plastics, (iii) detection of ingested plastics and the associated problems, and (iv) related economies and policy to ingested plastics. While there are many research questions on the topic of impacts of plastic pollution on biota that could be funded and investigated, our results focus collective priorities in terms of research that experts believe will inform effective policy and on-the-ground conservation.

Evaluation of the suitability of a plant virus, pepper mild mottle virus, as a surrogate of human enteric viruses for assessment of the efficacy of coagulation-rapid sand filtration to remove those viruses

Here, we evaluated the removal of three representative human enteric viruses - adenovirus (AdV) type 40, coxsackievirus (CV) B5, and hepatitis A virus (HAV) IB - and one surrogate of human caliciviruses - murine norovirus (MNV) type 1 - by coagulation-rapid sand filtration, using water samples from eight water sources for drinking water treatment plants in Japan. The removal ratios of a plant virus (pepper mild mottle virus; PMMoV) and two bacteriophages (MS2 and φX174) were compared with the removal ratios of human enteric viruses to assess the suitability of PMMoV, MS2, and φX174 as surrogates for human enteric viruses. The removal ratios of AdV, CV, HAV, and MNV, evaluated via the real-time polymerase chain reaction (PCR) method, were 0.8-2.5-log₁₀ when commercially available polyaluminum chloride (PACl, basicity 1.5) and virgin silica sand were used as the coagulant and filter medium, respectively. The type of coagulant affected the virus removal efficiency, but the age of silica sand used in the rapid sand filtration did not. Coagulation-rapid sand filtration with non-sulfated, high-basicity PACls (basicity 2.1 or 2.5) removed viruses more efficiently than the other aluminum-based coagulants. The removal ratios of MS2 were sometimes higher than those of the three human enteric viruses and MNV, whereas the removal ratios of φX174 tended to be smaller than those of the three human enteric viruses and MNV. In contrast, the removal ratios of PMMoV were similar to and strongly correlated with those of the three human enteric viruses and MNV. Thus, PMMoV appears to be a suitable surrogate for human enteric viruses for the assessment of the efficacy of coagulation-rapid sand filtration to remove viruses.

Intraocular Ossification in the GSP/pe Chicken With Imperfect Albinism

The eyes of 2 male and 2 female GSP/pe chickens, the imperfect albino strain, were investigated at 52 weeks of age. Aged chickens of the GSP/pe colony became blind with bilateral ocular enlargement and opaque lenses. Affected eyes (bilateral in 2 males and unilateral in 2 females) were hard and difficult to section; histologic specimens were processed after decalcification. A large portion of the posterior chamber was occupied by cancellous bone containing fibrous and cartilaginous foci. Osseous tissues developed adjacent to the choroid, and no retinal pigment epithelium (RPE) was detected between osseous tissues and the choroid. Small segments of degenerate neuronal retina were scattered in the osseous tissue. The irises and ciliary bodies were deformed by osseous tissue, and the lenses had severe cataracts. These observations suggest that the intraocular osseous tissue may be derived from RPE in the hereditary incomplete-albino strain of chickens.

STUDIES ON BOUND RUBBER OF CB BEFORE/AFTER VULCANIZATION OF ISOPRENE RUBBER

The high abrasion furnace (HAF), fast extrusion furnace (FEF), and fine thermal (FT) loadings used in this study were adjusted to keep the carbon black (CB)–specific area of cetyl trimethyl ammonium bromide adsorption to 2490 m2g−1. Their polyisoprene (IR) compounds and vulcanizates were investigated. Regarding the dependence of the CB gel fraction (FCB gel) on the IR gel/CB weight ratio (WRIR/CB), the amount of CB in the CB gel increased with a larger CB aggregate size, whereas the amount of the IR gel decreased. With regard to the dependence of the activation energy (ΔE(T2)) of the spin–spin relaxation time (T2) on the CB aggregate size, an immobilized rubber layer around CB formed more easily in the order of FT < FEF < HAF. Moreover, it became clear from the relationship between WRIR/CB and ΔE(T2) that the amount of the IR gel in the CB gel increased with decreasing ΔE(T2). The unique ratio of the surface area to the volume of CB aggregates (SCB/VCB) was obtained from results of three-dimensional transmission electron microscopy observation. The dependence of the amount of dibutyl phthalate (DBP) adsorption and compressed DBP adsorption on SCB/VCB was approximately linear, which suggested that SCB/VCB was closely related to CB aggregates and CB agglomerates. The linear relationship seen between SCB/VCB and ΔE(T2) revealed that an immobilized rubber layer was present around CB. The dependence of (qCB/qIR)(WRIR/CB) on SCB/VCB was also investigated using the densities (ρIR and ρCB) of IR and CB. The slope (tirl) of their approximately linear relationship was about 3.9 nm, which almost agreed with the bound rubber thickness reported in the literature to date. It is also inferred that because the intercept (α), which reflects the change in the IR gel weight fraction, was about 0.04 (4%), the IR gel weight fraction changed very little between before and after vulcanization.

Thymic stromal lymphopoietin expression is increased in the horny layer of patients with atopic dermatitis

Thymic stromal lymphopoietin (TSLP) is known for its capacity to induce CD11c(+) myeloid dendritic cells to promote T helper type 2 (Th2)-skewed inflammatory responses. Although increased expression of TSLP was reported in the lesional skin of limited numbers of patients with atopic dermatitis (AD), the relationships between the degree of TSLP expression in the skin and the severity of AD, epidermal barrier function and eruption type remain to be elucidated. The aim of this study was to examine the relationships between the degree of TSLP expression in the skin and the severity of AD, eruption type and epidermal barrier function using a non-invasive method in a sizeable group of the patients. Stratum corneum tissue was obtained from AD patients by tape stripping, and the stratum corneum TSLP (scTSLP) expression level was evaluated using a TSLP-specific antibody followed by image analysis. The correlations between the scTSLP intensity and the severity scoring of AD (SCORAD) index and epidermal barrier function, such as stratum corneum hydration and transepidermal water loss (TEWL), were analysed. The changes in the scTSLP level induced by the application of moisturizer were also examined. The scTSLP expression level was increased in AD patients compared with healthy subjects and was correlated with SCORAD, especially with the dry skin score, and stratum corneum hydration. Moisturizer application resulted in reduced scTSLP levels. The scTSLP level can be used as a biomarker of AD severity and particularly epidermal barrier status.

Comparisons of the effects of 12-week administration of miglitol and voglibose on the responses of plasma incretins after a mixed meal in Japanese type 2 diabetic patients

To compare the effects of miglitol [an alpha-glucosidase inhibitor (AGI) absorbed in the intestine] and voglibose (an AGI not absorbed) on plasma glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide (GIP) levels, 26 and 24 Japanese type 2 diabetic patients were randomly assigned to receive miglitol or voglibose, respectively. After 12-week administration of both drugs, during 2-h meal tolerance test, plasma glucose, serum insulin and total GIP were significantly decreased and active GLP-1 was significantly increased. Miglitol group showed a significantly lower total GIP level than voglibose group. Miglitol, but not voglibose, significantly reduced body weight (BW). In all participants, the relative change in BW was positively correlated with that of insulin significantly and of GIP with a weak tendency, but not of GLP-1. In conclusion, both drugs can enhance postprandial GLP-1 responses and reduce GIP responses. The significant BW reduction by miglitol might be attributable to its strong GIP-reducing efficacy.

Quality of life in thalassemia: a comparison of SF-36 results from the thalassemia longitudinal cohort to reported literature and the US norms

Thalassemia is a chronic, inherited blood disorder, which, in its most severe form, causes life-threatening anemia. Advances in treatment have led to increased life expectancy however the need for chronic blood transfusions and chelation therapy remains a significant burden for patients. Our study compared health related quality of life (HRQOL) from the Thalassemia Clinical Research Network's (TCRNs) Thalassemia Longitudinal Cohort (TLC) study to US norms and assessed association with clinical variables. There were 264 patients over age 14 who completed the Medical Outcomes Study 36-Item Short Form Health Survey version 2 (SF36v2) baseline assessment. When compared to US norms, TLC patients had statistically significant (P < 0.05) worse HRQOL on five of the eight subscales (physical functioning, role-physical, general health, social functioning, and role-emotional) and on both summary scales (physical component summary and mental component summary). Women, older patients, and those with more disease complications and side effects from chelation reported lower HRQOL. In general, adolescents and adults with thalassemia report worse HRQOL than the US population, despite contemporary therapy. The SF-36 should become a standard instrument for assessing HRQOL in thalassemia to determine predictors of low HRQOL which may be better addressed by a multidisciplinary team.

Risk factors for depression after kidney transplantation

OBJECTIVE

Kidney transplantation is recognized as the only potentially curative treatment for end-stage renal failure. But many psychiatric problems are associated with the procedure. The purpose of this study was to identify predictors of a risk for depression after kidney transplantation.

MATERIALS AND METHODS

This retrospective cohort study recruited 116 first kidney-only Japanese recipients whose mean age was 50.2 +/- 11.87 years include a male/female ratio of 63/53. They underwent transplantation between 1990 and 2008. At enrollment, we used the Zung Self-rating Depression Scale score as well as characterized demographic and clinical features of recipients and donors. Comparisons between depressed and non-depressed patients concerning sociodemographic and clinical characteristics were used chi(2) tests for categorical variables and Student's t-tests for continuous variables. Risk factors with significant correlation coefficients (P < .05) were entered into a stepwise logistic regression model to identify the best single risk factor for depression after kidney transplantation.

RESULT

The prevalence of depression in this study was 41.4%. Depressed patients were significantly more likely to not have regular incomes, nor to have desired kidney transplantation, to have experienced a rejection episode, and to live alone (P < .05). The single best predictor of future depression was living alone; subjects living alone were 2.51 times more likely to be depressed as those living with others (adjusted odds ratio [OR], 2.51; 95% confidence interval [CI], 1.31-5.22; P < .05).

CONCLUSION

Although depression after kidney transplantation is driven by multiple, complex, and often overlapping risk factors, we observed characteristic features of recipients including their social environment and follow-up treatment.

Time-frequency analysis for pulse driven ultrasonic microscopy for biological tissue characterization

The authors have proposed a new type of ultrasonic microscopy for biological tissue characterization. The system is driven by a nanosecond pulse voltage, the generated acoustic wave being reflected at the front and rear side of the sliced tissue. In this report, a time-frequency analysis was applied to determine the sound speed thorough the tissue. Frequency dependence of sound speed was obtained with a myocardium of a rat sliced into 10 microm. As the reflected waveform had a significant amount of oscillating component, the waveform was once subjected to the deconvolution process. As the result, two reflections were clearly separated in time domain. Then these two reflections were separately analyzed by time-frequency analysis. Each reflection was extracted by using a proper window function. Phase angles of these reflections at the same frequency were compared. A sound speed micrograph at an arbitrary frequency in between 50 and 150 MHz was successfully obtained. A tendency was found that the sound speed slightly increases with frequency.

A synchrotron X-ray study of triclinic LiCa2Nb3O10 with perovskite-type slabs

The triclinic superstructure of a small crystal of LiCa(2)Nb(3)O(10), lithium dicalcium triniobium decaoxide, has been investigated by synchrotron X-ray diffraction. The unit cell is an almost rectangular parallelepiped, although there is a 0.245 degrees offset from orthogonality for beta. The structure essentially belongs to a homologous series of Li[Na(n-3)Ca(2)Nb(n)O(3n+1)] with n = 3, where the moiety in square brackets has a perovskite-type slab structure. The superstructure has a doubled unit-cell volume with respect to the tetragonal aristotype. The NbO(6) octahedra are rotated about axes parallel to [110] by approximately 10 degrees. Adjacent slabs are connected by Li atoms and are geometrically related by 4(2) pseudosymmetry lying parallel to c. There are twice as many sites as Li atoms, providing a variation of population at these Li sites.

A comprehensive collection of mouse zinc finger motifs compiled by molecular indexing

The C(2)H(2) zinc finger motif found in many transcription factors is thought to be for nucleic acid binding and/or dimerization. Nearly 1% of eukaryote genes are estimated to encode this motif. We investigated the gene family encoding this motif in the Mus musculus mRNA by molecular indexing, a technique used to select a subpopulation of cDNA by ligation of adapters to cDNA fragments digested by a class IIS restriction enzyme(s). In place of oligo-dT primers in the original method, a polymerase chain reaction primer designed based on the conserved sequence of the C(2)H(2) zinc finger protein stranded cDNA was made from various mouse tissue mRNAs, digested with FokI and BsmAI, and joined with adapters. Amplification of the cDNA with an adapter primer and zinc finger-specific primer yielded products enriched in zinc finger protein genes. Fragments were separated by subsequent denaturing polyacrylamide gel electrophoresis, and characterized by DNA sequencing. Consequently, 259 C(2)H(2) zinc finger motif sequences were obtained, among which 166 were novel. Combined with the reported sequences, these mouse motif sequences were compared with those of other species such as Saccharomyces cerevisiae and Caenorhabditis elegans. Some of the amino acids in the motif sequence showed strong bias among species. Most of the novel sequences were supposed to be DNA-binding according to the surface potential of predicted tertiary structures.

Myosin I mutants with only 1% of wild-type actin-activated MgATPase activity retain essential in vivo function(s)

The single class I myosin (MYOA) of Aspergillus nidulans is essential for hyphal growth. It is generally assumed that the functions of all myosins depend on their actin-activated MgATPase activity. Here we show that MYOA mutants with no more than 1% of the actin-activated MgATPase activity of wild-type MYOA in vitro and no detectable in vitro motility activity can support fungal cell growth, albeit with a delay in germination time and a reduction in hyphal elongation. From these and other data, we conclude that the essential role(s) of myosin I in A. nidulans is probably structural, requiring little, if any, actin-activated MgATPase or motor activity, which have long been considered the defining characteristics of the myosin family.

Characterization of coagulase from Staphylococcus intermedius

A protein coagulase was isolated from Staphylococcus intermedius 6131 using bovine prothrombin-Sepharose 4B and Bio-gel P-4 column chromatographies. Homogeneity was demonstrated by the formation of a single band in polyacrylamide gel electrophoresis and isoelectric focusing. The purified preparation possesses a molecular weight of 64,500, an isoelectric point of 4.1, consists of 615 total amino acid residues and demonstrates coagulase activity for human and rabbit fibrinogen, but does not show the activity for rat or guinea pig fibrinogens. This purified protein contains galactose and fucose, and the amino-terminal amino acid sequence was determined. The coagulase activity is inhibited by N-bromosuccinimide (NBS), suggesting that tryptophan is involved in this activity. The coagulase was heat stable to 80 degrees C and stable to pH over the range of 7-9. This is the first report of coagulase from Staphylococcus intermedius.

Tissue-engineered product: allogeneic cultured dermal substitute composed of spongy collagen with fibroblasts

Recently, various types of allogeneic skin substitutes including cultured epidermal substitute (CES), cultured dermal substitute (CDS), and cultured skin substitute (CSS), which are composed of keratinocytes and/or fibroblasts as the cellular component(s), have been used as biological wound dressings. In our study, the allogeneic CDS was prepared by plating fibroblasts on a spongy collagen. The clinical evaluation was conducted using fresh or cryopreserved allogeneic CDS. In 145 of our clinical cases, 95% (138/145) of various wounds were evaluated as achieving good or excellent results, including 96% (22/23) of deep dermal burns (DDB) and dermal burns (DB), 100% (53/53) of partial-thickness donor wounds, 91% (21/23) of traumatic skin defects, 100% (5/5) of pressure ulcers, 82% (9/11) of chronic skin ulcers, 100% (6/6) of coverage for debrided DB, and 92% (22/24) of coverage for autologous meshed graft. The results obtained in our study suggest that the allogeneic CDS is able to provide an effective therapy for patients with partial and/or full-thickness skin defects.

Outreach strategies for Southeast Asian communities: experience, practice, and suggestions for approaching Southeast Asian immigrant and refugee communities to provide thalassemia education and trait testing

This article outlines general strategies for outreaching to Southeast Asian immigrant and refugee communities with thalassemia education. Because of positive net migration and increased birthrates during the last 15 years, Asian Pacific Islanders are among the fastest growing populations in California. Dr. Fred Lorey of California Newborn Screening shows that 1 of 12 Southeast Asians is a carrier of hemoglobin E, demonstrating a particular need to outreach to these communities. The challenge of educating Southeast Asian populations include language barriers, differences in cultural and/or religious beliefs, geographic location, and unfamiliarity with and/ or mistrust of Western health care systems. In addition, outreach workers must consider the great diversity of ethnicity, language, literacy, and education levels, and degree of acculturation to the US within the Asian/Southeast Asian groups. It is crucial before embarking on any outreach campaign to understand the history and make-up of the target audience, including ethnic minorities and dialects, to translate written materials into appropriate languages or audio formats, and to have a group of trained interpreters for events. Additionally, a continuing education model for the outreach/medical staff is important to maintain robust understanding of these diverse communities. Specific strategies include using visual aids, medical professionals as authority figures, and bicultural high school and college students during presentations. Finally, establishing trust and maintaining a continued presence in communities are the most important aspects of a successful outreach campaign.

Thyroid function in wholly breast-feeding infants whose mothers take high doses of propylthiouracil

BACKGROUND

Propylthiouracil (PTU) might theoretically be preferred over methimazole (MMI) during breast-feeding because of its lower milk/serum concentration ratio (0.1 vs. 1.0). The problem is that Graves' disease often relapses during the postpartum period, and high doses of PTU are sometimes needed to control maternal hyperthyroidism) during breast-feeding. However, there are virtually no data on the effects of maternal PTU on thyroid status of infants whose mothers take more than 300 mg PTU daily and who are wholly breast-feeding.

OBJECTIVES

To investigate whether mothers can breast-feed without adverse effects on infants' thyroid status while taking 300 mg or more daily of PTU.

SUBJECTS AND DESIGN

Eleven infants who were wholly breast-fed while their mothers took PTU 300-750 mg daily for Graves' hyperthyroidism were included in this study. In one of the 11 infants, the mother also took iodine 6 mg daily for a limited period. Thyroid status in these infants was evaluated.

MEASUREMENTS

Free T4 (FT4), thyrotrophin (TSH), and TSH binding inhibiting antibody (TBIAb) concentrations were examined at least once in the age range 6 days to 9 months. Maternal blood was also examined for FT4 and TBIAb on the same day, or within a week, of the infants' blood tests. FT4, TSH and TBIAb concentrations at birth were examined, using cord blood, in cases where antithyroid drugs had been continued through delivery.

RESULTS

Three of the 11 infants had TSH concentrations higher than the normal range for adults. In one of the three infants, the TSH concentration, which was determined 19 weeks after birth, was just above the normal range. In the remaining two infants whose mothers had taken PTU through delivery, TSH concentrations, determined within 7 days after birth, were distinctly high, but they became normal while maternal PTU doses were the same as or higher than those at the initial examination. Maternal PTU doses or FT4 concentrations were not significantly correlated with infants' TSH concentrations.

CONCLUSION

Mothers can breast-feed while taking propylthiouracil at doses as high as 750 mg daily without adverse effects on thyroid status in their infants.

Frontal sinus adenocarcinoma

CONTEXT

Paranasal sinus cancer is considered rare, with an incidence of less than 1 per 100,000 per year, with the frontal sinus being the primary site in only 0.3%. We report a case of adenocarcinoma arising in the frontal sinus.

DESIGN

Case report.

CASE REPORT

A 59-year-old woman, secretary, came in February 1998 with a 4-month history of low intensity frontal headache. She denied contact with wood dust. On examination a non-tender swelling was noted over her right forehead next to the medial aspect of the right orbit. CT scan showed a soft-tissue mass involving frontal sinus with intracranial invasion through the posterior wall. The anterior ethmoid sinus and the medial aspect of the right orbit were also involved. MRI demonstrated dural thickening in communication with the frontal mass. She underwent an en-bloc tumor resection by craniotomy including orbital clearance. Histology revealed an adenocarcinoma. After surgery she had tumor recurrence, and chemotherapy and radiotherapy were started resulting in partial improvement.

Regulation of human jaw tapping force with visual biofeedback

The purpose of this study, which made use of visual biofeedback, was to determine whether jaw tapping force reproduction is related to the strength of tapping and to investigate how jaw tapping force affects the tapping movement curve. Nine healthy examinees were asked to reproduce jaw tapping force. We found that the ease and method of regulating jaw tapping force differed depending on the target force. We also found that jaw tapping force was regulated by alteration of the jaw opening distance, the duration of the tooth contact phase, the duration of the jaw closing phase, the maximum jaw opening velocity, and the maximum jaw closing velocity. However, the duration of the jaw opening phase and cycle time was not affected by force regulation under our experimental conditions.

Prognostic comparison between peripheral and central types of squamous cell carcinoma of the lung in patients undergoing surgical resection

In order to define whether the location of the tumor [peripheral (P) or central (C)] may have some influence on the prognosis for patients with squamous cell carcinoma of the lung, we analyzed 235 patients under 80 years of age (P-group = 129, C-group = 106) who had undergone surgical resection between January 1985 and December 1997. There was no significant difference in the prognosis between the two groups with stages I(0)-IIIB of the disease. We concluded that as a whole the location of the tumor may not have significant influence on the prognosis in patients with squamous cell carcinoma of the lung undergoing surgical resection.

Head, neck and trunk movements accompanying jaw tapping

Several studies have examined the functional relationship between mandibular movement and head or body posture, but head and body motion during jaw movement have not been extensively investigated. Ten healthy participants performed repetitive jaw tapping movement. Piezoelectric accelerometers were attached on the surfaces of the participant's forehead, mentum, and over the spinous processes of the sixth cervical, twelfth thoracic and third lumbar vertebrae. The direction in which the antero-posterior acceleration signals appeared around the onsets of jaw opening and closing were observed for the period from the 6th to the 25th strokes of the jaw tapping. Around the onset of jaw opening, the forehead and the lumbar vertebra tended to move posteriorly, but the cervical and thoracic vertebrae moved anteriorly with significant frequencies. The directions of the motions of these locations reversed themselves at the beginning of jaw closing; so the motions of the forehead and the lumbar vertebra were opposed again to the ones of the cervical and thoracic vertebrae. The results suggest that the head extend-flex motion often accompanied the jaw open-close movement, and the motions of the neck and trunk existed, which would serve the purpose of promoting the mandible to move smoothly.

Fatal pulmonary thromboembolism in gastrectomy intraoperative procedures by gastric adenocarcinoma: case report

The case of a patient with gastric adenocarcinoma with indication for gastrectomy is reported. The surgery took place without complications. A palliative, subtotal gastrectomy was performed after para-aortic lymph nodes compromised by neoplasm were found, which was confirmed by pathological exam of frozen sections carried out during the intervention. At the end of the gastroenteroanastomosis procedure, the patient began to show intense bradycardia: 38 beats per minute (bpm), arterial hypotension, changes in the electrocardiogram's waveform (upper unlevelling of segment ST), and cardiac arrest. Resuscitation maneuvers were performed with temporary success. Subsequently, the patient had another circulatory breakdown and again was recovered. Finally, the third cardiac arrest proved to be irreversible, and the intra-operative death occurred. Necropsy showed massive pulmonary embolism. The medical literature has recommended heparinization of patients, in an attempt to avoid pulmonary thromboembolism following major surgical interventions. However, in the present case, heparinization would have been insufficient to prevent death. This case indicates that it is necessary to develop preoperative propedeutics for diagnosing the presence of venous thrombi with potential to migrate, causing pulmonary thromboembolism (PTE). If such thrombi could be detected, preventative measures, such as filter installation in the Cava vein could be undertaken.

Lung carcinoma in patients age younger than 30 years

BACKGROUND

To the authors' knowledge, no study regarding lung carcinoma patients age <30 years has been published. Therefore, this study was undertaken to define the characteristics of lung carcinoma patients age <30 years.

METHODS

Information regarding 26 patients with primary lung carcinoma who were age <30 years was obtained from 10 medical institutions and reviewed retrospectively. For comparison, 304 patients age > or = 30 years who were admitted to the First Department of Internal Medicine at Toyama Medical and Pharmaceutical University between 1980-1996 were studied.

RESULTS

Among the characteristics observed in the group of lung carcinoma patients age <30 years was a high incidence of female gender, no history of smoking, so-called "low grade malignancy," American Joint Committee on Cancer Stage I disease, and previous surgical resection. In addition, a low incidence of squamous cell carcinoma was noted, and a more favorable prognosis was observed.

CONCLUSIONS

The current study noted clinical features that could be defined clearly in lung carcinoma patients age <30 years.

Chitin-graft-poly(2-methyl-2-oxazoline) enhanced solubility and activity of catalase in organic solvent

Catalase from bovine liver was lyophilized from an aqueous solution containing chitin-graft-poly(2-methyl-2-oxazoline) (3), which was synthesized by the reaction of 52% deacetylated chitin (1) with living poly(2-methyl-2-oxazoline) (2). The rate of consumption of H2O2 in chloroform catalyzed by the lyophilized catalase with 3 was enhanced more than 10 times that by catalase without 3. The dispersibility and solubility of lyophilized catalase with 3 in chloroform were improved in comparison with catalase itself.

Propagation of various tooth impacts in the human body

The purpose of this study was to investigate how far tooth impacts were propagated in the body and whether the propagation would be influenced by posture. The impacts were propagated to all recording sites on the head and neck of the 10 examinees tested. In the recordings on the limbs, even at the most distal site, the number of examinees detecting the vibration was seven out of nine examinees. These results showed that the impacts exerted on the tooth were propagated to distal sites of limbs through the bones and soft tissues and implied that the propagated vibration would influence the whole of the body. On the other hand, as the amplitude of propagated vibration was influenced by posture and recording site, the posture during jaw functioning appears to be important.

Direct evidence of autosomal recessive inheritance of Arg24 to termination codon in purine nucleoside phosphorylase gene in a family with a severe combined immunodeficiency patient

Purine nucleoside phosphorylase (PNP) deficiency is a rare immunodeficiency disease involving a T-lymphocyte-dysfunction that is fatal unless bone marrow transplantation is successful. In this study we undertook genetic analysis of a patient with PNP deficiency. Sequencing of the PNP gene, which is located on chromosome 14ql3, of the patient led to the identification of three point mutations in exon 2 at amino acid positions 20 (His, silent mutation), 24 (Arg-->termination codon) and 51 (Ser-->Gly). Intrafamilial sequence analysis of exon 2 revealed that both parents were heterozygous for the Arg24 and termination codon 24 alleles. Two of their three children had inherited different homozygous alleles, termination codon 24 for the patient, and Arg24 for his healthy sibling. Transcriptional termination was suggested as the mechanism giving rise to the disorder in this case. A lack of PNP protein was also confirmed by immunoblot analysis of the patient's hemolysate. This could be the first report providing evidence of autosomal recessive inheritance in PNP deficiency by sequence-based analysis.

Prognosis for patients with pneumonectomy or lesser resections for non-small cell lung cancer based on histologic cell type

Contrary results have been reported regarding prognosis by histologic cell type in surgical treatment for lung cancer. To evaluate whether histologic cell type has influence on prognosis, we separately analyzed the prognostic outcome of patients who had undergone pneumonectomy (n=119) and lesser resections (n=124) for non-small cell lung cancer (NSCLC) between January, 1985 and March, 1996. The pneumonectomy group included 87 (73%) squamous cell carcinoma (Sq), 25 (21%) adenocarcinoma (Ad) and 7 other types with 10 (8%) patients in postoperative stage I of the disease, 29 (24%) stage II, 74 (62%) stage III and 6 in stage IV. The lesser resection group included 45 (36%) Sq, 63 (51%) Ad and 16 other types with 71 (57%) patients in stage I, 9 (7%) stage II, 32 (26%) stage III and 12 stage IV. In patients with stages I-III, the 5-year survival rate was 42.8% for the Sq group and 41.1% for the Ad group in the case of lesser resections and 37.1% for the Sq group and 0% for the Ad group (p<0.05) in the case of pneumonectomy. The poorer prognosis for patients with Ad in the case of pneumonectomy was suspected to be due to the N factor; the percentage of patients with N0-1 was significantly lower in the Ad group than for the Sq group (28 vs 62%, p<0.005). Histologic cell type can be a prognostic factor for patients undergoing surgical treatments for NSCLC. One possible reason for the contrary results on prognosis by histologic cell type among investigators may be due to the mixed results of pneumonectomy and lesser resections.

Transcriptional regulation of fatty acid cyclooxygenases-1 and -2

Transcriptional regulation of fatty acid cyclooxygenase isozymes (COX-1 and COX-2) were studied using two cell lines. A rapid and transient induction of COX-2 was observed by the addition of tumor necrosis factor alpha (TNF alpha) to murine osteoblastic cells MC3T3-E1. Possible involvement of NF kappa B and NF-IL6 as transcription factors was shown by deletion experiments using a luciferase reporter gene. COX-1 induction by a phorbol ester was demonstrated along with differentiation of human megakaryoblastic cells CMK to megakaryocytes.

Results of pneumonectomy for non-small cell lung cancer: appropriateness of the new TNM staging system

In the new TNM staging system for lung cancer in 1997, stage T3N0M0 was revised from stage IIIA to stage IIB. Therefore, we initiated a study to assess the appropriateness of this revision. One hundred and nineteen patients who had undergone pneumonectomy for non-small cell lung cancer (NSCLC) between January 1985 and March 1996 were analyzed. They included 87 squamous cell carcinoma (sq), 25 adenocarcinoma (ad), 4 large cell carcinoma (la), and 3 adenosquamous cell carcinoma (ad-sq), with 10 patients in postoperative stage I (3 IA + 7 IB), 29 stage II (1 IIA + 28 IIB), 74 stage III (39 IIIA + 35 IIIB) and 6 in stage IV of the disease. Stage IIB included 14 patients with T3N0M0 (12 sq, 1 ad, 1 la). The 5-year survival rate for patients with T3N0M0 was 69.6%, which was superior to that (55.7%) for patients with stage II (T1-2N1M0) of the previous system. According to the new TNM staging system, the 5-year survival rate was 40% in stage I, 66.2% in stage II, 24% in stage IIIA, 0% in stages IIIB and IV (stage I vs stage II, NS; stage II vs stage IIIA, p<0.01; stage IIIA vs stage IIIB, p<0.01; stage IIIB vs stage IV, p<0.01). A significant prognostic difference between stage II and stage IIIA was observed, which had not been observed in the previous system. Our results show that the revision of T3N0M0 from stage IIIA to stage II in the new TNM staging system seems appropriate with regard to the pneumonectomy group.

Prostaglandin D synthase in human megakaryoblastic cells

The cytosol fraction of human platelets did not convert prostaglandin (PG) H2 to PGD2. However, a homogenate of human megakaryoblastic CMK cells (precursor cells of platelets) produced PGD2 from PGH2. The PGD synthase activity was localized in the cytosol of CMK cells, and absolutely required glutathione. The catalytic properties and Western and Northern blottings indicated that the enzyme was PGD synthase of the hematopoietic type rather than the lipocalin type. When CMK cells were differentiated to megakaryocytes with phorbol ester along with induction of cyclooxygenase-1, the PGD synthase activity increased about 2-fold for 2 days and then decreased. In another human megakaryoblastic cell line, Dami, the PGD synthase increased about 10-fold by the addition of phorbol ester. Thus, the PGD synthase, which was undetectable in platelets, appeared during differentiation of megakaryoblasts to megakaryocytes.

Detection of polyanion-restricted anti-histone antibodies in patients with systemic lupus erythematosus

The nature of the antibodies responsible for lupus erythematosus (LE) cells in systemic lupus erythematosus (SLE) remains obscure. We examined whether polyanion-restricted anti-histone antibodies were present in serum of patients with SLE using Western blotting analysis. Dextran sulfate or alginate was used as a polyanion compound in place of DNA. Antibodies which recognized dextran sulfate-histone complexes were present in serum of patients with SLE (17/34, 50%). These antibodies were detected in most SLE patients positive for LE cells (17/18, 94%) but not in those negative for LE cells or in patients with other collagen diseases. Similar results were obtained using alginate-histone complexes as antigens for Western blotting analysis. The antibodies to dextran sulfate-histone or alginate-histone complexes in serum of SLE patients were completely absorbed by treatment of serum with DNA-histone complexes, while they were unaffected by treatment with DNA only. The presence of antibodies to free histones and dextran sulfate-histone complexes did not seem to be related to the titer of anti-single stranded DNA antibody and anti-double stranded DNA antibody. We demonstrated the presence of polyanion-restricted antibodies in SLE, which may be responsible for the LE factor.

[A case of completion pneumonectomy with carinal wedge resection after sleeve upper lobectomy for right lung cancer]

A 58-year-old man underwent sleeve upper lobectomy for squamous cell carcinoma of the right lung in April 1993. Eleven months after the operation, local recurrence at the bronchial suture line was detected by bronchoscopy. As the patient declined our proposal for performing reoperation, the recurrent tumor was treated with concurrent radiotherapy and chemotherapy, which resulted in only minimal response. After these treatment, the tumor was still localized at the right pulmonary hilus with no distant metastasis, and patient's pulmonary function was preserved good enough to undergo reoperation. Therefore, with a patient's consent to reoperation, we performed completion pneumonectomy with carinal wedge resection in September 1994. Pedicled serratus anterior muscle flap was applied to the suture line in order to prevent anastomotic complications. Postoperative course was uneventful except for pneumonia, and the anastomosis had healed well. As of March 1997 the patient is alive with no evidence of tumor recurrence. Completion pneumonectomy with carinal resection carries a high risk of operative morbidity and is seldom indicated. We reported a patient underwent this procedure for recurrent lung cancer and discussed about its indication and procedure.

Results of pneumonectomy for non-small cell lung cancer

To assess the role of pneumonectomy for lung cancer and the factors affecting the prognosis, 107 patients who had undergone pneumonectomy for non-small cell lung cancer (NSCLC) between January, 1985 and March, 1996, were analyzed. They included 81 squamous cell carcinoma, 22 adenocarcinoma, 3 large cell carcinoma, and one adenosquamous cell carcinoma, with 8 patients in post-operative stage I, 15 in stage II, 51 in stage IIIA, and 33 in stage IIIB of the disease. The 5-year survival rate was 54.7% in stages I + II, 38.0% in stage IIIA, and <4% in stage IIIB. In stages I-IIIA, the patients with squamous cell carcinoma showed a significantly better prognosis than those with adenocarcinoma (50.6 vs. 0%, p < 0.01). The prognosis was also better, but not statistically significant, for patients with central type compared with those with peripheral type in both all histologic types (58.0 vs. 8.4%) and only squamous cell type (59.3 vs. 18.8%). A better prognosis observed in squamous histologic type or central type seemed to be related to a better N factor. Pneumonectomy remains the treatment of choice for lung cancer, but seems not to be justified for patients with stage IIIB due to their poor prognosis.

Survival and prognosis after pneumonectomy for lung cancer in the elderly

BACKGROUND

The number of elderly patients with lung cancer is increasing. This study was undertaken to assess the validity of pneumonectomy for the treatment of lung cancer in this patient group.

METHODS

Twenty-seven patients 70 years old or older (elderly group) and 95 patients younger than 70 years (younger group) who underwent pneumonectomy between January 1985 and March 1996 formed the study group. In the elderly group, 22 patients had squamous cell carcinoma, 2 had adenocarcinoma and 3, small cell carcinoma; 1 patient was in postoperative stage I, 4 patients were in stage II, 14 in stage IIIA, 5 in stage IIIB, and 3 in stage IV of the disease. The only significant differences in patient characteristics between the two groups were the percentage of patients undergoing right pneumonectomy and the percentage of patients receiving chemotherapy or radiotherapy within 3 months before or after operation or both times.

RESULTS

The prognosis for the elderly group was comparable to that of the younger group for all stages of the disease; the overall 5-year survival rate was 30.5% for the younger group and 11.5% for the elderly group. However, operation-associated mortality was significantly higher in the elderly group (22.2% versus 3.2%; p < 0.005). The prognosis was better for patients with a centrally located tumor than a peripheral tumor in both groups [13.5% versus 2.0% in the elderly group and 46.7% versus 5.2% (p < 0.01) in the younger group] and significantly better for patients having a left pneumonectomy than a right pneumonectomy in the younger group (46.7% versus 5.2%; p < 0.01) but not in the elderly group (13.7% versus 22.2%). Adjuvant treatment did not have any beneficial effect on the prognosis in either group.

CONCLUSIONS

Pneumonectomy for lung cancer in elderly patients appears to be justified because the outcome in our study was comparable with that for the younger patients. However, it should be performed only in carefully selected patients because of the increased operative risk.