Analysis of public discourse on heart transplantation in Japan using social network service data

The clarification of public concerns regarding heart transplantation is important for improving low organ donation rates in Japan. In the present study, we used the Twitter data of 4986 tweets (between August 2015 and January 2016) and 1429 tweets (between April 2016 and May 2016) to analyze public discourse on heart transplantation in Japan and identify the reasons for low organ donation rates. We manually categorized all tweets relevant to heart transplantation into nine categories and counted the number of tweets in each category per month. During the study period, the most popular category of tweets was related to the media, followed by money (tweets questioning or even criticizing the high price of fundraising goals to go overseas for heart transplantations), while some tweets were misconceptions. We also conducted a sentiment analysis, which revealed that the most popular negative tweets were related to money, while the most positive tweets were related to reports on the favorable outcomes of recipients. Our results suggest that listening to concerns, providing correct information (particularly for some misconceptions), and emphasizing the outcomes of recipients will facilitate an increase in the number of people contemplating heart transplantation and organ donation.

Risk factors for maternal outcome in pregnancy complicated with dilated cardiomyopathy

OBJECTIVE

The goal of the study was to determine risk factors for maternal cardiac failure in pregnancy complicated with dilated cardiomyopathy (DCM).

STUDY DESIGN

The subjects were 29 patients diagnosed with DCM before conception or during the first 7 months of pregnancy. DCM was defined as left ventricle end-diastolic dimension (LVDd)≥48 mm and/or fractional shortening (%FS)≤30% on echocardiography. Patients were followed until at least 1 year after delivery and were categorized into a poor prognosis group (n=6; death or end stage heart failure of New York Heart Association (NYHA) class III and IV) and a good prognosis group (n=23; all other cases).

RESULT

DCM was initially diagnosed during pregnancy in 6/6 and 8/23 patients in the poor and good prognosis groups, respectively (P<0.005). The %FS of the first test during pregnancy was 17.5±6.2 and 27.4±9.3% in the respective groups (P<0.005). In eight abortion cases with %FS 15.2±3.1%, %FS, cardiac function and NYHA class were maintained until 20 months after abortion. There was no relationship between LVDd and maternal outcome.

CONCLUSION

Onset during pregnancy and decreased %FS are risk factors for a poor maternal outcome in patients with DCM. Abortion prevents further deterioration of cardiac function in patients with a very low %FS.

Lack of association between a polymorphism in the promoter region of the dopamine D2 receptor and personality traits

Disturbances of the dopaminergic neurotransmitter system have been associated with a personality trait that involves novelty seeking. A functional polymorphism in the promoter region of the dopamine D2 receptor gene (DRD2) has been reported to be associated with schizophrenia. We examined the association between this polymorphism in the DRD2 promoter region and personality traits, as assessed with the Tridimensional Personality Questionnaire. No significant association emerged between the polymorphism in the DRD2 promoter region and personality traits. Entering sex and age as covariates in an analysis of covariance did not change the results. These data fail to confirm an association between a polymorphism in the promoter region of the DRD2 and personality traits.

Suppression of conditioned fear by administration of CCKB receptor antisense oligodeoxynucleotide into the lateral ventricle

We investigated the role of CCK in the development of anxiety by determining whether CCKB receptor antisense suppressed intracellular Ca(2+) concentration in vitro or suppressed conditioned fear stress in vivo. First, for the in vitro studies, we used rat pituitary tumor GH3 cells since these cells have CCKB receptors. GH3 cells were stimulated by 10 microM CCK-4; intracellular Ca(2+) concentration was measured. The CCKB receptor antisense at 1 or 10 microM reduced the subsequent response to 10 microM CCK-4 in a time-dependent manner. Second, for the in vivo studies, the CCKB receptor antisense, sense, random sense, or saline was infused at a constant rate for 6 days into rat lateral ventricles via mini-osmotic pumps. Individual rats were then subjected to 30 min of inescapable electric footshock in a chamber with a grid floor. Twenty-four hours later, the rat was again placed in the chamber and observed for 5 min without shocks. This study showed that CCKB receptor antisense significantly suppressed intracellular Ca(2+) concentration in GH3 cells and significantly reduced freezing behavior in rats, indicating that the CCKB receptor plays an important role in anxiety.

Differences between the tolerance characteristics of two anticonvulsant benzodiazepines in the amygdaloid-kindled rat

The characteristics of the development of tolerance to the anticonvulsant effects of chronic treatment by dipotassium clorazepate and diazepam using amygdaloid-kindled rats were investigated. Dipotassium clorazepate (5 mg/kg) or diazepam (5 mg/kg) were intraperitoneally administered for 10 consecutive days. Tolerance to the anticonvulsant effect of dipotassium clorazepate developed in seizure stage on day 6, after-discharge duration on day 7 and seizure latency on day 4. In contrast, tolerance to the effects of diazepam developed more rapidly in seizure stage on day 4, after-discharge duration on day 4 and seizure latency on day 3. Thus tolerance to the anticonvulsive effect of dipotassium clorazepate developed relatively slower than that to diazepam. All rats had stage 5 convulsions 24 hr after cessation of the administration of dipotassium clorazepate and diazepam. Concomitant determinations of plasma concentrations of the main metabolite of dipotassium clorazepate and diazepam, desmethyldiazepam, showed no statistical difference during treatment, suggesting that the developed tolerance was not metabolic but functional.

Increased anxiety behavior in OLETF rats without cholecystokinin-A receptor

Cholecystokinin (CCK) may have a role in the mediation of human panic disorder and anxiogenic (anxiolytic)-like activity in an animal model of anxiety. Otsuka Long Evans Tokushima Fatty (OLETF) rats lacked CCK A receptors (CCKAR) because of a genetic abnormality. In order to elucidate the involvement of CCKAR in the regulation of anxiety, we investigated the exploratory behavior on elevated plus-maze test, the black and white box test, and open field test with OLETF rats in comparison with normal [Long-Evans Tokushima Otsuka (LETO)] rats. And OLETF rats increased the number of stretched attend postures and decreased open arm entry and the % time of open arm in an elevated plus-maze test. Time spent in the white box decreased significantly in OLETF rats than LETO rats. The total line crossing decreased significantly in OLETF rats compared to LETO rats. The missing CCKAR had a significant anxiogenic-like effect. These data support the involvement of the CCKAR in the neurobiological mechanism of anxiety.

Late onset X-linked hydrocephalus with normal cerebrospinal fluid pressure

A family with X-linked hydrocephalus with normal cerebrospinal fluid (CSF) pressure and in which three brothers and a grandson of case 1, a proband, were affected is reported. The symptoms at onset were epileptic attacks that started in adulthood in the three brothers and at the age of 6 years in the grandson. In the three brothers, from 10 to 27 years after the onset of epileptic episodes, disorganization of intelligence and psychiatric deterioration were gradually noticed by their families. At the same time, they showed occasional urinary incontinence. Brain computed tomography (CT) scans revealed dilatation of the ventricular systems. Based on the results of the measurement of CSF pressure and radioactive-iodinated human serum albumin (RISA)-cysternography, two of the brothers were diagnosed as having normal pressure hydrocephalus (NPH), and they were treated neurosurgically. However, no obvious improvement in clinical symptoms was observed. Although the grandson had shown normal psychomotor development during his early childhood, temporal epilepsy and temper tantrums started at the age of 6 years. Computed tomography-scanning revealed dilatation of the ventricular system similar to the other three cases at the age of 8 years. With the diagnosis of NPH, the patient underwent a shunt operation, which resulted in no obvious effects. As it is reasonable to surmise that the pathological gene would have been transferred via the daughter of the proband to the grandson, it is suggested that the inheritance manner might be X-linked recessive. The cases presented here are different from the cases of hydrocephalus due to stenosis of the aqueduct Sylvius (HSAS) and other types of X-linked hydrocephalus reported previously in terms of the age of onset, course, symptoms, and CT findings. Thus, it is suggested that the present cases might be a new type of X-linked hydrocephalus.

Characteristics of epilepsy in severely mentally retarded individuals

In order to clarify the characteristics of epilepsy in patients with severe mentally retarded (SMR) subjects, we analyzed 52 SMR subjects with epilepsy from the institute for SMR subjects at Kikuchi National Hospital, Kumamoto, Japan. A total of 61.5% patients had uncontrolled seizures which were resistant to treatment. The most common combinations of seizure types in those not responding to conventional anticonvulsants were generalized tonic-clonic seizures (GTCS) with tonic seizure and GTCS with atypical absence. Their clinical features were characterized by spastic paralysis associated with a slower background electroencephalogram and abnormal computed tomography scans of the head, suggesting the involvement of cortical damage. These findings suggest that a large proportion of epilepsy in SMR subjects does not respond to treatment and that the severity of organic brain damage may therefore affect the natural course of epilepsy in such patients.

High-resolution ultrastructure of amyloid fibrils in familial amyloid polyneuropathy

The ultrastructure of amyloid fibrils in familial amyloid polyneuropathy (FAP) was clearly demonstrated. Amyloid of three patients with FAP caused by the point mutation of the 30th amino acid of transthyretin (ATTR Val30Met) and one patient with FAP caused by two point mutations of the 30th and 104th amino acid of transthyretin (ATTR Val30Met/Arg104Cys) were partially isolated, stained negatively and examined with an electron microscope. Amyloid fibrils of both types were composed of two protofilaments and twisted at 180 degrees to the right and left alternately with a periodicity of 125-135 nm. This is the first report demonstrating such unique alternating twist structure of amyloid fibrils. There were no ultrastructural differences between the fibrils caused by the ATTR Val30Met and ATTR Val30Met/ Arg104His; therefore, it is suggested that the point mutation of the 30th amino acid of transthyretin might play an important role in the formation of amyloid fibrils. Further biochemical study on the mechanism of this alternating twist formation should be undertaken.

Effect of dipotassium clorazepate on amygdaloid-kindling and comparison between amygdaloid- and hippocampal-kindled seizures in rats

We examined the effect of dipotassium clorazepate (7-chloro-1, 3-dihydro-2-oxo-5-phenyl-1H-1, 4-benzodiazepine-3-carboxylate potassium hydroxide), an antianxiety drug, on amygdaloid kindling and compared its effects for 7 successive days on amygdaloid- versus hippocampal-kindled seizures, using the rat kindling model of epilepsy. Dipotassium clorazepate at 5 mg/kg significantly delayed amygdaloid kindling. The contralateral cortical after-discharge duration in the dipotassium clorazepate-treated group was significantly shorter than the after-discharge duration in the amygdala in the first seven stimulations, whereas it was significantly shorter only in the first three stimulations in the control group, indicating that dipotassium clorazepate suppressed the spread of seizure activity from focus to contralateral cortex. Dipotassium clorazepate suppressed amygdaloid-kindled seizures at 2 and 5 mg/kg, while 1 mg/kg or more suppressed hippocampal-kindled seizures. Thus, differences in effective dosages in both amygdaloid- and hippocampal-kindled seizures may suggest a difference in the neuronal mechanisms involved in this kindling.

A case study of Cotard's syndrome: stages and diagnosis

We report the case of a middle-aged woman with Cotard's syndrome in whom clinical course was evaluated according to stages. Longitudinally this syndrome seems to have three stages, namely germination, blooming and chronic (depressive type/paranoid type) stages. In this patient, the chronic stage, primarily characterized by delusions, was observed without raising suspicion of affective disorder. She did not respond to any pharmacotherapies, but improved dramatically after ECT performed during the chronic stage. Although symptoms change according to the stage, most cases of Cotard's syndrome may belong to the affective spectrum and are probably best treated with ECT, as documented here. In evaluation of the mode of separation between emotion and cognition during follow-up it is important to consider stage and diagnosis.

Association between serotonin transporter gene polymorphism and anxiety-related traits

BACKGROUND

Polymorphism in the serotonin transporter promoter gene has been recently reported to be associated with the personality trait known as anxiety-related traits. We have attempted to replicate these findings in 101 healthy Japanese subjects.

METHODS

The personality traits of the subjects were assessed with the tridimensional personality questionnaire.

RESULTS

An association was observed in the present study between individuals grouped according to the transporter gene and harm avoidance scores.

CONCLUSIONS

These data supported that there was an association between the serotonin transporter gene and anxiety.

Nuclear localization of the delta subunit of Ca2+/calmodulin-dependent protein kinase II in rat cerebellar granule cells

To examine the physiological roles of the delta subunit of Ca2+/calmodulin-dependent protein kinase II (CaM kinase IIdelta) in brain, we examined the localization of CaM kinase IIdelta in the rat brain. A specific antibody to CaM kinase IIdelta1-delta4 isoforms was prepared by immunizing rabbits with a synthesized peptide corresponding to the unique carboxyl-terminal end of these isoforms. The prepared antibody did not recognize the alpha, beta, and gamma subunits, which were each overexpressed in NG108-15 cells. Immunoblot analysis on various regions and the nuclear fractions from rat brains suggested that some isoforms of CaM kinase IIdelta1-delta4 were abundant in the nucleus in the cerebellum. Total RNA from the cerebellum was analyzed by RT-PCR with a primer pair from variable domain 1 to variable domain 2. We detected the three PCR products delta3.1, delta3.4, and delta3 that contained the nuclear localization signal. These CaM kinase IIdelta3 isoforms were localized in the nuclei in transfected NG108-15 cells. Immunohistochemical study suggested the existence of these isoforms in the nuclei in cerebellar granule cells. These results suggest that CaM kinase IIdelta3 isoforms are involved in nuclear Ca2+ signaling in cerebellar granule cells.

Relationship between SCL-90, Maudsley Personality Inventory and CCK4-induced intracellular calcium response in T cells

This study examined the relationship between the Symptom Checklist 90 (SCL-90), Maudsley Personality Inventory (MPI) and cholecystokinin 4 (CCK4)-induced intracellular calcium response in T cells. Fifty-two normal volunteers were 37 males and 15 females; they ranged in age from 23 to 44 years. Measures included CCK4-induced intracellular calcium response in T cells, SCL-90 scores, and MPI. Paranoid ideation and interpersonal sensitivity in SCL-90 showed a significant negative association with CCK4-induced intracellular calcium response. Absent were sex differences and extroversion and neuroticism correlations. There were no significant differences between men and women in SCL-90 or MPI scores. There was no correlation among extroversion and neuroticism and CCK4-induced intracellular calcium response. CCKB receptor function might play a role in paranoid ideation and interpersonal sensitivity.

Better working conditions won by 'nurse wave' action: Japanese nurses' experience of getting a new law by their militant campaign

Japanese nurses, like their counterparts in many other countries, are suffering from staff shortages and severe working conditions. The Japan Federation of Medical Workers' Unions (Nihon Iroren) launched a campaign in 1989 for nurses called the 'Nurse Wave'. Their demands were many: to increase the numbers of nursing staff, the regulation of night shifts, the implementation of a five-day working week everywhere, a fair appraisal of nurses' work, better vocational training, etc. Nurses in white uniforms assembled at meetings, marched and took part in nation-wide strikes. They collected over 5.4 million petition signatures, which they submitted to Parliament. After three years of campaigning, they won the enactment of a law for securing sufficient numbers of nursing personnel. This struggle, which highlighted the most pressing demands of nurses and was supported by the general public, was a new experience for Japanese nurses. It was a militant movement which demanded that the Government should change its health policy. Against the sluggish image of the Japanese labour movement, strikes and demonstrations organized by nurses dressed in white have made a strong impression on the Japanese people. As health care is a public service on which the life and death of people depend, a strike at a health institution naturally has constraints and must follow specific procedures. In this article, the measures taken by Nihon Iroren to minimize the consequences of strikes on patients and the local community, the impact of the nurses' movement on the society, as well as the lessons drawn from the campaign, are presented.

Identification of monocyte chemoattractant protein-1 in senile plaques and reactive microglia of Alzheimer's disease

It has been shown that human monocytes express monocyte chemoattractant protein-1 (MCP-1), an inflammatory factor, in response to non-fibrillar beta-amyloid protein. Reactive microglia and inflammatory factors were reported to be present in beta-amyloid deposits (senile plaques) in Alzheimer's disease, suggesting the presence of MCP-1 in senile plaques. To address this issue, we examined MCP-1 immunoreactivity in senile plaques using a mouse monoclonal anti-MCP-1 antibody. Monocyte chemoattractant protein-1 was found immunohistochemically in mature senile plaques and reactive microglia but not in immature senile plaques of brain tissues from five patients with Alzheimer's disease. These findings suggest that MCP-1-related inflammatory events induced by reactive microglia contribute to the maturation of senile plaques.

Expression and distribution of CC chemokine macrophage inflammatory protein-1 alpha/LD78 in the human brain

Macrophage inflammatory protein (MIP)-1 alpha, also known as LD78, is a member of a family of chemokines which recruit leukocytes to sites of inflammation. We have shown by Northern blot analyses that MIP-1 alpha mRNA is expressed in several human tissues, including brain. To explore MIP-1 alpha distribution in brain tissue, we immunohistochemically examined brain tissues from 13 neuropsychiatric patients. Glial cells in the white matter of brain tissues from four patients with schizophrenia and one with manic depressive illness were MIP-1 alpha positive. Glial cells in the cortex from these patients were negative, except in one patient with schizophrenia in whom neurones as well as glial cells in the cortex stained positively for MIP-1 alpha. In situ hybridization showed that MIP-1 alpha mRNA was expressed in both neurones as well as glial cells in this patient. These results suggest a heterogeneous distribution of MIP-1 alpha in human brain.

Erythrocyte deformability in schizophrenic patients

Erythrocyte deformability as a clinical indicator of microcirculatory disturbance was determined in the erythrocyte of 25 schizophrenic patients and of 18 normal controls. Schizophrenic patients had significantly lower erythrocyte deformability than did the normal controls (P < 0.001). This result suggests that microcirculation in schizophrenic patients is disturbed, and that this disturbance might be involved in the pathophysiological genesis of schizophrenia.

Immunohistochemical examination of phosphorylated tau in granulovacuolar degeneration granules

Granulovacuolar degeneration (GVD) and neurofibrillary tangles (NFT) are neuropathological features in Alzheimer's disease (AD). The molecular mechanism of GVD formation remains unknown. Recent immunohistochemical investigations suggested a potential link of NFT to GVD formation. Enzyme histochemical studies and electronmicroscopic findings suggested that GVD is formed through lysosomal autophagy of intraneuronal substances. We recently demonstrated that in non-demented cases NFT was phosphorylated at serines 199, 202 and 422 in paired helical filament (PHF)-tau more than in serine 396, while NFT in AD cases was similarly phosphorylated at these four sites in tau. In this study, we demonstrated immunohistochemically a similar phosphorylation state of tau in GVD granules to that in NFT in both non-demented cases and AD patients by using a mouse monoclonal anti-tau antibody and three phosphorylation site-specific antibodies for PHF-tau, indicating that GVD granules and NFT are composed of similar phosphorylated-tau. However, we could not detect PHF structures within any GVD using electronmicroscopy, indicating that PHF itself is not phagocytized by lysosomes during GVD formation. Therefore, the source of GVD granules might be phosphorylated pre-PHF-tau.

Morphological investigation of neurofibrillary tangles in Alzheimer's disease

There are two types of neurofibrillary tangles, namely, a twisted tubule and a straight or uniform tubule in the same cell in the brain with Alzheimer's disease. However, in some parts of the same fibril, both the twisted and straight tubules clearly could be seen as a continuation of each other. This finding suggests that both of the tubules have a deep relation to each other, especially at the molecular level. This might also suggest the possibility of both tubules which mutually transform into each other.

The distribution of α1-antichymotrypsin and amyloid production in the brain in Alzheimer’s disease

In this immunohistopathological study alpha 1-antichymotrypsin, which is barely demonstrable in the normal brain, was found in amyloid fibrils, endothelial cells and the cytoplasm of astroglial cells in brains from patients with Alzheimer's disease. Amyloid precursors stained with methenamine silver were arrayed mainly along the membranes, and amyloid fibrils, which stained densely with anti-alpha 1-antichymotrypsin, were in direct contact with the fibrous structures connecting with the membranes of vascular feet or astrocytic processes. From the above findings, alpha 1-antichymotrypsin seems to play a role in the production of amyloid fibrils in Alzheimer's disease.

Morphological study of amyloid fibrils and preamyloid deposits in the brain with Alzheimer's disease

In addition to the ultrastructural study of amyloid fibrils, amyloid fibrils and preamyloid in the brain which had the fine ultrastructure of a well-preserved neuropil were examined using methenamine silver stain by light and electron microscope. In serial sections, amyloid fibrils in extracellular spaces continued directly to the capillaries. Using methenamine silver stain, silver granules were deposited at the amyloid fibrils and in extracellular spaces forming diffuse plaques. Many silver granules in the extracellular spaces seemed to strain preamyloid surrounding the capillaries. These findings to indicate that the capillaries have an important role in the formation of amyloid fibrils at least in some senile plaques.

Ultrastructure of neurofibrillary tangles in Alzheimer's disease by means of tilt-stage electron microscopy

Neurofibrillary tangles (NFT) in the brains of patients with Alzheimer's disease were examined by means of tilt-stage electron microscopy. Observing a longitudinal direction, constricted parts of the NFT did not move in an axial direction. In a transverse section, a fibril of the NFT consisted of globular subunits having a hollow structure in the center and did not appear as paired filaments. From these findings, it was considered that a fibril of NFT consists of twisted protofilaments made up of globular subunits and does not consist of paired helical filaments.

Vascular changes in the brains with Alzheimer's disease

Sections of temporal and occipital cortex from 14 patients with Alzheimer's disease were examined by light and electron microscopy. Especially, areas without senile plaques or neurofibrillary degeneration were examined in detail. The initial change in the cerebral cortex occurred in the capillaries. The endothelial cells demonstrated degeneration with hypertrophic distorted basement membranes and swelling of the vascular feet. Lipochromes were found in the processes and cell bodies of the astrocytes. A decrease in the number of nerve cells and their processes noted in the cortices may be due to primary vascular degeneration. Severe dementia in Alzheimer's disease may be related to the histopathological findings of diffusely destroyed nerve cells and their processes.

Ultrastructure of senile plaque using thick sections in the brain with Alzheimer's disease

The subjects used in the present study consisted of 8 cases with Alzheimer's disease. Senile plaques which seemed to have no relation with the capillaries were examined in thick serial sections (3,000-5,000 A) by electron microscope. The results obtained were as follows: All of those senile plaques had amyloid angiopathy with amyloid fibrils and these amyloid fibrils formed the main elements of senile plaques. From these findings, it was confirmed that the amyloid fibrils in all plaques are produced from the capillaries.

Ultrastructure of neurofibrillary tangles in Alzheimer's disease

The ultrastructure of neurofibrillary tangles (NFT) was examined by electron microscopy. The fibrils of NFT seemed to consists of about eight protofilaments consisting of globular subunits; these protofilaments were helically wound in a longitudinal direction. The fibrils of NFT had hollow structures at their centers surrounded by the eight globular subunits. The subunits were tightly connected in the narrow parts of the fibril, but more loosely connected in the wider parts. From these findings, it seemed that the fibrils of NFT consist of a twisted tubule having periodical constrictions and is made up of eight helically wound protofilaments, forming globular subunits.

Histopathological changes induced by disturbance of microcirculation in the rat brain

Microcirculatory disturbance was induced in 8 rats after injecting microsphere latex (5 micron in diameter) from the right carotid artery. Ultrastructural observations revealed that initial changes occurred in the vascular feet of astroglial cells and the subsequent swelling of postsynapses. Succeedingly presynapses and nerve cells also became atrophic but this was considered to be caused by astrocytic degeneration. From these findings, it is speculated that the neuronal atrophy was secondary to the changes in the neuropil around the capillary caused by disturbance of the nutritional supply from the blood induced by microcirculatory disturbance. The above described findings seemed to have some similarity to those of nonspecific degeneration of the cortex observed in the brain, such as Alzheimer's disease.

Ultrastructure of perivascular amyloid fibrils in Alzheimer's disease

Perivascular amyloid fibrils in the brains of patients with Alzheimer's disease have been examined by electron microscopy. The amyloid fibrils showed a hollow rod structure and consisted of globular substances. Each turn appeared to be composed of five globular subunits. These findings coincide with the ultrastructure of amyloid fibrils obtained from replicas made by a rapid freezing method.

Pathological findings of the sural nerve in mitochondrial encephalomyopathy

We examined the muscle and peripheral nerve of a 55-year-old woman with familial mitochondrial encephalomyopathy. In the gastrocnemius muscle, many ragged red fibers and mitochondria containing paracrystalline inclusions in those fibers were observed by light and electron microscopy, respectively. Histopathological studies of the sural nerve revealed a marked decrease in the number of large myelinated fibers. Electron microscopic studies showed an accumulation of glycogen particles and mitochondria containing abnormal, structurally obscure cristae in the Schwann cell cytoplasm. These results suggest that the cause of loss of the large myelinated fibers may be some disturbance of metabolism in the Schwann cells due to mitochondrial dysfunction.

An autopsy case of idiopathic superficial hemosiderosis of the central nervous system: a microscopic and immunohistochemical study

The brain of a patient with idiopathic superficial hemosiderosis of the central nervous system was examined by light and electron microscopy. A histopathological study revealed massive, symmetrically situated necrosis in the temporal and insular lobes, which has not been described in previous reports. In addition, immunohistochemistry revealed ovoid bodies in the astroglia. Electron microscopy showed that these bodies were composed of fine granules, 50-60 A in diameter, and electron-dense amorphous material. Based on detailed histopathological and ultrastructural findings, the mechanism of ovoid body formation is discussed.

Wilson's disease with extensive degeneration of cerebral white matter and cortex

This is a report of an autopsy case of Wilson's disease with widespread degeneration of the cerebral cortex and white matter, the basal ganglia and thalamus and, to a lesser degree, the cerebellum and brain stem. The patient was a 28-year-old man at the time of death with the clinical course of a 20-year duration. The lesions consisted of spongy degeneration leading to a cavity formation with insufficient glia fiber proliferation. We noted the characteristic findings of Alzheimer glia (Types I and II) and Opalski cells and the new formation in capillaries. The distribution of the changes in the hemispheres showed the typical pattern with a tendency of preferential superior and anterior localization and a relative preservation of the hippocampal formation, carcarine areas, amygdaloid nuclei and the hypothalamus. Similar cases in the literature were reviewed.

Ultrastructural changes of blood vessels in the cerebral cortex in Alzheimer's disease

Several parts of the cerebral cortices in five brains from patients with Alzheimer's disease were examined by light and electron microscopes. The results obtained are as follows: The initial change of the cerebral cortex in the brain occurred in the small blood vessel and capillary. The endothelial cell of the blood vessel fell into a degenerated state with swelling of the vascular feet and astroglial cells. The change in a great number of nerve cells and their processes diffusely observed in the cortices were nonspecific and could be due to primary vascular degeneration. Severe dementia in Alzheimer's disease seemed to be well explained by the histopathological findings of diffusely destroyed nerve cells and their processes. From this, Alzheimer's disease can be speculated to be a disease caused by progressive capillary degeneration.

Synthetic parathyroid hormone fragments shortened at the amino terminus stimulate glucose-6-phosphate dehydrogenase activity in the distal renal tubule

The cytochemical bioassay, using glucose-6-phosphate dehydrogenase (G6PD) activity in the distal convoluted tubule of a guniea pig as an index, is specific and the most sensitive method of evaluating the biological activity of parathyroid hormone (PTH). Using this method, biological activities of the amino- or carboxyl-terminal PTH fragments and analogues, human (h) PTH-(3-34), [Tyr34]hPTH-(7-34)amide(NH2), [Tyr34]hPTH-(13-34)NH2, hPTH-(39-84), hPTH-(51-84), hPTH-(69-84), were tested over a concentration range of 10(-16) to 10(-13) M. In addition, the combined effect of these hormones with human or bovine PTH-(1-84) and the effect of dibutyryl (Bu)2) cAMP were also evaluated. In the 14-min time-course study, amino-terminal PTH fragments and analogues induced cyclic changes of G6PD activity with shorter cycle lengths in higher concentrations and with constant peak heights regardless of the concentrations. Human and bovine PTH-(1-84) showed the same activity on G6PD activation at 6 min. hPTH-(3-34), [Tyr34]hPTH-(7-34)NH2, and [Tyr34]hPTH-(13-34)NH2 were equipotent with PTH-(1-84) on a molar basis, and none of these analogues inhibited PTH-(1-84) even with doses up to 240 times that of PTH-(1-84). Carboxyl-terminal PTH showed no effect. (Bu)2cAMP mimicked the effect of PTH-(1-84) on G6PD activation in time course and dose response. We conclude that the amino terminus is not essential for the biological activity of PTH in the cytochemical bioassay.

Familial mitochondrial encephalomyopathy with stroke-like episodes and episodic disturbances of consciousness: a study of pedigree including three generations with multisystemic abnormalities

We report here two cases in a family with pleomorphic clinical features which include mitochondrial myopathy, encephalopathy, stroke-like episodes, episodic disturbances of consciousness and other multisystemic abnormalities. The other signs observed in multisystemic abnormalities were ophthalmoplegia, short stature, diabetes mellitus, diabetes insipidus, renal dysfunction, optic atrophy, retinal degeneration, impairment of hearing and mental retardation or deterioration. A symptomatological variation was observed in cases in the same family. It is suggested that these widely varying symptoms may be expressions caused by a common biochemical defect which involves different tissues in different individuals in the family. The syndromes observed in the present cases were compared with other possibly-related mitochondrial encephalomyopathies.

Ultrastructure of amyloid fibrils in Alzheimer's disease and Down's syndrome

Amyloid fibrils in brains of patients with Alzheimer's disease and Down's syndrome were examined by light and electron microscopy. In addition, replicas of amyloid fibrils produced by a quick freezing method from the brain of a patient with Down's syndrome were examined by electron microscopy. The amyloid fibrils were shown to consist of hollow rods. These were composed of filaments arranged as a tightly coiled helix, each turn of which consisted of five globular subunits. This structure appears to be similar to the prion filament observed in Creutzfeldt-Jakob disease (CJD). The possibility therefore arises that amyloid fibrils in Alzheimer's disease and Down's syndrome may be related to the transmissible agents responsible for diseases such as CJD, kuru and Gerstmann-Sträussler Syndrome (GSS).

Status spongiosus in Creutzfeldt-Jakob disease

The initial stage of status spongiosus in Ammon's horn of two brains with panencephalopathic type of Creutzfeldt-Jakob disease (PE-CJD) was examined electron microscopically. The results obtained in this examination were as follows: initial formation of large vacuoles or cavities seemed to be the result of distension within cell processes, mainly astrocytes, and these vacuoles and cavities might gradually form status spongiosus. A very important finding in the present study was that all kinds of glial cells showed degenerative changes. It is concluded that glial insufficiency might be one of the pathogenetic mechanisms effective in panencephalopathic Creutzfeldt-Jakob disease.

Ultrastructural studies of amyloid fibrils and senile plaques in human brain

Amyloid fibrils and senile plaques in brains with Alzheimer's disease, senile dementia and Down's syndrome were examined by light and electron microscopy. In addition, replicas of amyloid fibrils, made by a quick freezing method from a brain with Down's syndrome, were examined. All amyloid masses forming the cores of senile plaques consisted of numerous amyloid fibrils spreading from the walls of small blood vessels to the surrounding parenchyma. The amyloid fibrils ran in various directions, forming bundle-like groups in a geometrical array. They appeared as rods with hollow structures consisting of an array of globular units in the replicas, while they showed bead-like structure in the tissue specimens of 500-nm thick sections. The ultrastructure of replicas reveals a new finding on the structure of amyloid fibrils in the human brain.

Studies of circulating parathyroid hormone in man by a homologous amino-terminal specific radioimmunoassay

A homologous radioimmunoassay specific for amino-terminal portion of human parathyroid hormone(PTH) was developed in order to study the clearance of biologically active species of the hormone in the circulation in man. Characterization of the assay system with synthetic analogues of human PTH (1-34) indicated that the carboxyl-terminal region of human PTH(1-34) is an important recognition site. Plasma amino-terminal PTH levels were less than 0.3 ng/ml in all of 35 normal subjects. The levels were elevated above 0.3 ng/ml in 15 of 24 patients with primary hyperparathyroidism. In 5 patients in whom the levels were determined before and after parathyroidectomy, the elevated levels were all normalized within 60 minutes after the removal of adenomata. The disappearance of exogenous human PTH(1-34) was studied after intravenous administration in 17 patients with hypoparathyroidism. A graphical analysis of the data disclosed two major components of the disappearance curve with estimated half-disappearance time of 3 and 28 minutes respectively, suggesting that multiple mechanisms are involved in the clearance of the peptide from the circulation. These results demonstrate usefulness of homologous radioimmunoassay for human PTH(1-34) in diagnosis and management of hyperparathyroidism, as well as in studying the clearance of amino-terminal portion of PTH which is known to represent biological activity.

Homologous radioimmunoassay for human carboxyl-terminal parathyroid hormone and its clinical evaluation

An homologous radioimmunoassay for human carboxyl-terminal parathyroid hormone (PTH) was developed using the antiserum raised against synthetic human PTH (46-84) and its clinical evaluation was attempted. Antisera were produced in guinea pigs by immunization with synthetic human PTH (46-84) conjugated with BSA. One of the antisera was used at a final concentration of 1 : 10,000 in the assay, and synthetic human PTH (53-84) for a standard and 125I-Tyr45 human PTH (46-84) for a tracer were used. A standard curve was obtained at concentrations from 0.001 to 10 ng per tube of human PTH (53-84). The displacement curves for human PTH (51-84), human PTH (46-84), Tyr45 human PTH (46-84) and bovine PTH (1-84) were almost identical with the standard curve made by synthetic human PTH (53-84). This antiserum, however, did not recognize the human PTH (1-34) fragment at all. Using this assay system, circulating immunoreactive PTH was measured in normal subjects and patients with parathyroid disorders. Normal PTH values in serum ranged from 0.47 ng/ml to an undetectable level (undetectable in two out of 32 normal subjects) and serum PTH values in patients with primary or secondary hyperparathyroidism or idiopathic hypoparathyroidism were almost completely discriminated from normal values. These results suggest that this homologous radioimmunoassay is a carboxyl-terminal specific assay for human PTH and can be quite useful in clinical practice.

Picornavirus-like inclusions in polymyositis--aggregation of glycogen particles of the same size

We studied picornavirus-like inclusions in muscle of a 66-year-old man with chronic polymyositis. Inoculation of a muscle homogenate to suckling mice and VeRo cells failed to detect any virus. After treatment of ultrathin sections with 2% amylase, individual particles that constituted inclusions were digested, as were free glycogen particles in the same section. Particles of the inclusions were stained with periodic acid-thiocarbohydrazide-silver proteinate and alkaline-bismuth, as were glycogen particles. The picornavirus-like inclusions seemed to consist of glycogen particles than form a crystalline arrangement in degenerated muscle fibers.