Position paper on olfactory dysfunction

Background

Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following: • Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy with small diameter endoscopes. • Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability. • Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour threshold, and/or one of odour identification or discrimination. • Comprehensive chemosensory assessment should include gustatory screening. • Smell training can be helpful in patients with olfactory loss of several aetiologies.

Conclusions

We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.

Inducing and manipulating magnetization in 2D zinc-oxide by strain and external voltage

Two-dimensional (2D) structures that exhibit intriguing magnetic phenomena such as perpendicular magnetic anisotropy and its switchable feature are of great interests in spintronics research. Herein, the density functional theory studies reveal the critical impacts of strain and external gating on vacancy-induced magnetism and its spin direction in a graphene-like single layer of zinc oxide (ZnO). In contrast to the pristine and defective ZnO with an O-vacancy, the presence of a Zn-vacancy induces significant magnetic moments to its first neighboring O and Zn atoms due to the charge deficit. We further predict that the direction of magnetization easy axis reverses from an in-plane to perpendicular orientation under a practically achievable biaxial compressive strain of only ~1-2% or applying an electric field by means of the charge density modulation. This magnetization reversal is mainly driven by the strain- and electric-field-induced changes in the spin-orbit coupled d states of the first-neighbor Zn atom to a Zn-vacancy. These findings open interesting prospects for exploiting strain and electric field engineering to manipulate magnetism and magnetization orientation of 2D materials.

CXCR2 Inhibition in Human Pluripotent Stem Cells Induces Predominant Differentiation to Mesoderm and Endoderm Through Repression of mTOR, β-Catenin, and hTERT Activities

On the basis of our previous report verifying that chemokine (C-X-C motif) receptor 2 (CXCR2) ligands in human placenta-derived cell conditioned medium (hPCCM) support human pluripotent stem cell (hPSC) propagation without exogenous basic fibroblast growth factor (bFGF), this study was designed to identify the effect of CXCR2 manipulation on the fate of hPSCs and the underlying mechanism, which had not been previously determined. We observed that CXCR2 inhibition in hPSCs induces predominant differentiation to mesoderm and endoderm with concomitant loss of hPSC characteristics and accompanying decreased expression of mammalian target of rapamycin (mTOR), β-catenin, and human telomerase reverse transcriptase (hTERT). These phenomena are recapitulated in hPSCs propagated in conventional culture conditions, including bFGF as well as those in hPCCM without exogenous bFGF, suggesting that the action of CXCR2 on hPSCs might not be associated with a bFGF-related mechanism. In addition, the specific CXCR2 ligand growth-related oncogene α (GROα) markedly increased the expression of ectodermal markers in differentiation-committed embryoid bodies derived from hPSCs. This finding suggests that CXCR2 inhibition in hPSCs prohibits the propagation of hPSCs and leads to predominant differentiation to mesoderm and endoderm owing to the blockage of ectodermal differentiation. Taken together, our results indicate that CXCR2 preferentially supports the maintenance of hPSC characteristics as well as facilitates ectodermal differentiation after the commitment to differentiation, and the mechanism might be associated with mTOR, β-catenin, and hTERT activities.

Position paper on olfactory dysfunction

BACKGROUND

Olfactory dysfunction is an increasingly recognised condition, associated with reduced quality of life and major health outcomes such as neurodegeneration and death. However, translational research in this field is limited by heterogeneity in methodological approach, including definitions of impairment, improvement and appropriate assessment techniques. Accordingly, effective treatments for smell loss are limited. In an effort to encourage high quality and comparable work in this field, among others, we propose the following ideas and recommendations. Whilst the full set of recommendations are outlined in the main document, points include the following: - Patients with suspected olfactory loss should undergo a full examination of the head and neck, including rigid nasal endoscopy with small diameter endoscopes. - Subjective olfactory assessment should not be undertaken in isolation, given its poor reliability. - Psychophysical assessment tools used in clinical and research settings should include reliable and validated tests of odour threshold, and/or one of odour identification or discrimination. - Comprehensive chemosensory assessment should include gustatory screening. - Smell training can be helpful in patients with olfactory loss of several aetiologies.

CONCLUSIONS

We hope the current manuscript will encourage clinicians and researchers to adopt a common language, and in so doing, increase the methodological quality, consistency and generalisability of work in this field.

Effect of relative humidity on preeclampsia

PURPOSE OF INVESTIGATION

The authors aimed to determine the relationship between meteorological variables and hypertension in pregnancy by using data from a national weather database.

MATERIALS AND METHODS

For this population-based observational study, the database of the Korea National Health Insurance (KNHI) Claims of the Health Insurance Review and Assessment Service (HIRA) and Korea Meteorological Administration was used. The 48,275 women with preeclampsia among 2,495,383 women who gave birth were included. Monthly meteorological factors and preeclampsia prevalence for five years were statistically analyzed.

RESULTS

Among temperature, relative humidity, sunlight duration, and rainfall, only relative humidity had a significant inverse correlation with the preeclampsia prevalence (p < 0.001). The other meteorological factors were not associated with preeclampsia.

CONCLUSION

Relative humidity may be a significant factor for of the development of preeclampsia. Further monitoring of weather parameters during the entire pregnancy period may be the best method for verifying the present results in the development of preeclampsia.

Association between Postprocedural Infarction and Antiplatelet Drug Resistance after Coiling for Unruptured Intracranial Aneurysms

BACKGROUND AND PURPOSE

Procedure-related thromboembolism is a major limitation of coil embolization, but the relationship between thromboembolic infarction and antiplatelet resistance is poorly understood. The purpose of this study was to verify the association between immediate postprocedural thromboembolic infarction and antiplatelet drug resistance after endovascular coil embolization for unruptured intracranial aneurysm.

MATERIALS AND METHODS

This study included 338 aneurysms between October 2012 and March 2015. All patients underwent postprocedural MR imaging within 48 hours after endovascular coil embolization. Antiplatelet drug resistance was checked a day before the procedure by using the VerifyNow system. Abnormal antiplatelet response was defined as >550 aspirin response units and >240 P2Y12 receptor reaction units. In addition, we explored the optimal cutoff values of aspirin response units and P2Y12 receptor reaction units. The primary outcome was radiologic infarction based on postprocedural MR imaging.

RESULTS

Among 338 unruptured intracranial aneurysms, 134 (39.6%) showed diffusion-positive lesions on postprocedural MR imaging, and 32 (9.5%) and 105 (31.1%) had abnormal aspirin response unit and P2Y12 receptor reaction unit values, respectively. Radiologic infarction was associated with advanced age (65 years and older, P = .024) only with defined abnormal antiplatelet response (aspirin response units ≥ 550, P2Y12 receptor reaction units ≥ 240). P2Y12 receptor reaction unit values in the top 10th percentile (>294) were associated with radiologic infarction (P = .003). With this cutoff value, age (adjusted odds ratio, 2.29; 95% confidence interval, 1.28-4.08), P2Y12 receptor reaction units (>294; OR, 3.43; 95% CI, 1.53-7.71), and hyperlipidemia (OR, 2.05; 95% CI, 1.04-4.02) were associated with radiologic infarction in multivariate analysis.

CONCLUSIONS

Radiologic infarction after coiling for unruptured aneurysm was closely associated with age. Only very high P2Y12 receptor reaction unit values (>294) predicted postprocedural infarction. Further controlled studies are needed to determine the precise cutoff values, which could provide information regarding the optimal antiplatelet regimen for aneurysm coiling.

Magnetism and magnetocrystalline anisotropy of 3dtransition metal monolayers on Pt(001): a density-functional study

We systematically investigate the effects of having Pt as a substrate and/or capping layer on the magnetism and magnetocrystalline anisotropy (MCA) of 3d transition metal (TMs; Cr, Mn, Fe, and Co) monolayers (MLs) by using a first-principles calculationl method. We found that Fe and Co MLs are ferromagnetic (FM) on a Pt(001) surface, but Mn and Cr MLs are antiferromagnetic (AFM). The magnetic moments are quite robust with additional Pt-capping. Furthermore, Pt-capping enhances the small perpendicular MCA (meV) of Fe/Pt(001) significantly to 4.44 meV. Our electronic structure analyses indicate that strong hybridization between Pt-5d and TM-3d orbitals plays a crucial role in determining magnetic ordering and MCA. For comparison we also calculated magnetism and MCA of 3d TM MLs on Ta(001) with and without Ta-capping.

Magnetic anisotropy energy and effective exchange interactions in Co intercalated graphene on Ir(1 1 1)

The electronic structure, magnetic moments, effective exchange interaction parameter and the magnetic anisotropy energy of [monolayer Co]/Ir(1 1 1) and Co intercalated graphene on Ir(1 1 1) are studied making use of the first-principles density functional theory calculations. A large positive magnetic anisotropy of 1.24 meV/Co is found for [monolayer Co]/Ir(1 1 1), and a high Curie temperature of 1190 K is estimated. These findings show the Co/Ir(1 1 1) system is a promising candidate for perpendicular ultra-high density magnetic recording applications. The magnetic moments, exchange interactions and the magnetic anisotropy are strongly affected by graphene. Reduction of the magnetic anisotropy and the Curie temperature are found for graphene/[monolayer Co]/Ir(1 1 1). It is shown that for graphene placed in the hollow-hexagonal positions over the monolayer Co, the magnetic anisotropy remains positive, while for the placements with one of the C atoms on the top of Co it becomes negative. These findings may be important for assessing the use of graphene for magnetic recording and magnetoelectronic applications.

TNF-α and LPS activate angiogenesis via VEGF and SIRT1 signalling in human dental pulp cells

AIM

To assess whether SIRT1 and VEGF are responsible for tumour necrosis factor-α (TNF-α) and lipopolysaccharide (LPS)-induced angiogenesis and to examine the molecular mechanism(s) of action in human dental pulp cells (HDPCs).

METHODOLOGY

Immortalized HDPCs obtained from Prof. Takashi Takata (Hiroshima University, Japan) were treated with LPS (1 μg mL(-1) ) and TNF-α (10 ng mL(-1) ) for 24 h. mRNA and protein levels were examined by RT-PCR and Western blotting, respectively. Migration and tube formation were examined in human umbilical vein endothelial cells (HUVECs). The data were analysed by one-way anova. Statistical analysis was performed at α = 0.05.

RESULTS

LPS and TNF-α upregulated VEGF and SIRT1 mRNA and protein levels. Inhibition of SIRT1 activity by sirtinol and SIRT1 siRNA or inhibition of the VEGF receptor by CBO-P11 significantly attenuated LPS + TNF-α-stimulated MMPs production in HDPCs, as well as migration and tube formation in HUVECs (P < 0.05). Furthermore, sirtinol, SIRT1 siRNA and CBO-P11 attenuated phosphorylation of Akt, extracellular signal-regulated kinase (ERK), p38 and c-Jun N-terminal kinase (JNK) and the nuclear translocation of NF-κB p65. Pre-treatment with inhibitors of p38, ERK, JNK, PI3K and NF-κB decreased LPS + TNF-α-induced VEGF and SIRT1 expression, MMPs activity in HDPCs and angiogenesis (P < 0.05) in HUVECs.

CONCLUSIONS

TNF-α and LPS led to upregulation of VEGF and SIRT1, and subsequent upregulation of MMP-2 and MMP-9 production, and promote angiogenesis via pathways involving PI3K, p38, ERK, JNK and NF-κB. The results suggest that inhibition of SIRT1 and VEGF might attenuate pro-inflammatory mediator-induced pulpal disease.

Case report of granular cell tumor of the vulva and review of current literature

► We present four cases of benign granular cell tumours of the vulva managed between 1998 and 2001. ► We discuss the clinical and histopathological features of this condition. ► Treatment of this condition is primarily surgical.

Automated segmentation of hippocampal subfields in drug-naïve patients with Alzheimer disease

BACKGROUND AND PURPOSE

Although a few automated hippocampal subfield segmentation methods have been developed, there is no study on the effects of the diagnosis of Alzheimer disease on the hippocampal subfield volume with in vivo MR imaging. The aim of this study was to investigate hippocampal subfield volume differences between drug-naïve subjects with AD and healthy elderly controls by using an automated hippocampal subfield segmentation technique.

MATERIALS AND METHODS

Thirty-one drug-naïve subjects with AD and 33 group-matched healthy control subjects underwent 3T MR imaging, and hippocampal subfield volume was measured and compared between the groups.

RESULTS

Subjects with AD had significantly smaller volumes of the presubiculum, subiculum, CA2-3, and CA4 DG compared with healthy subjects (uncorrected, P<.001). In addition, we found significant positive correlations between the presubiculum and the subicular volumes and the MMSE-K and the CERAD-K verbal delayed recall scores in the AD group.

CONCLUSIONS

We are unaware of previous imaging studies of automated hippocampal subfield segmentation in AD. These structural changes in the hippocampal presubiculum, subiculum, and CA2-3 might be at the core of underlying neurobiologic mechanisms of hippocampal dysfunction and their relevance to verbal delayed recall impairments in AD.

Soybean aphid and soybean cyst nematode interactions in the field and effects on soybean yield

How above- and belowground plant pests interact with each other and how these interactions affect productivity is a relatively understudied aspect of crop production. Soybean cyst nematode, Heterodera glycines Ichinohe, a root parasite of soybean, Glycine max (L.) Merr., is the most threatening pathogen in soybean production and soybean aphid, Aphis glycines Matsumura, an aboveground phloem-feeding insect that appeared in North America in 2000, is the key aboveground herbivore of soybean in the midwestern United States. Now, both soybean aphid and soybean cyst nematode co-occur in soybean-growing areas in the Upper Midwest. The objectives of this study were to examine aphid colonization patterns and population growth on soybean across a natural gradient of nematode density (range, approximately 900 and 27,000 eggs per 100 cm3 soil), and to investigate the effect of this pest complex on soybean productivity. Alate (winged) soybean aphid colonization of soybean was negatively correlated to soybean cyst nematode egg density (r = -0.363, P = 0.0095) at the end of July, at the onset of peak alate colonization. However, both a manipulative cage study and openly colonized plants showed that soybean cyst nematode density below ground was unrelated to variation in aphid population growth (r approximately -0.01). Based on regression analyses, soybean aphids and cyst nematodes had independent effects on soybean yield through effects on different yield components. High soybean cyst nematode density was associated with a decline in soybean yield (kg ha(-1)), whereas increasing soybean aphid density (both alate and apterous) significantly decreased seed weight (g 100 seeds(-1)).

Ectopic pregnancy in previous Caesarean section scar

We report two cases of Caesarean scar pregnancies that were managed surgically. The first case was a 33-year-old woman who presented at 21 weeks of gestation with lower abdominal pain. An exploratory laparotomy was performed as she was hypotensive and had a drastic drop in haemoglobin level. Intraoperatively, a ruptured scar ectopic pregnancy with placenta percreta was found. A hysterectomy was performed in view of uncontrolled haemorrhage. The second case was a 30-year-old woman who presented with irregular per vaginal spotting without abdominal pain. Ultrasonography revealed a gestational sac at a previous Caesarean scar, with interval increase in size and development of a yolk sac. On laparoscopy, the diagnosis of scar pregnancy was confirmed, and the gestational sac and surrounding myometrium were excised. Our case report shows that early diagnosis of scar pregnancy is important, as timely intervention can prevent life-threatening complications and preserve fertility.

Soybean cyst nematode effects on soybean aphid preference and performance in the laboratory

Herbivores on plants frequently interact via shared resources. Studies that have examined performance of herbivores in the presence of other herbivores, however, have often focused on above-ground feeding guilds and relatively less research has examined interactions between below- and above-ground consumers. We examine how soybean aphid, Aphis glycines (Matsumura) an above-ground phloem-feeding herbivore, interacts with a below-ground plant parasite, soybean cyst nematode, Heterodera glycines (Ichinohe) through their shared host plant, soybean (Glycine max L). Laboratory experiments evaluated the preference of alate (flight-capable) soybean aphids toward plants either infected with soybean cyst nematode or uninfected controls in a simple choice arena. Alate soybean aphids preferred uninfected soybean over soybean cyst nematode-infected plants: 48 h after the releases of alate aphids in the center of the arena, 67% more aphids were found on control soybean compared with nematode infected plants. No-choice feeding assays were also conducted using clip cages and apterous (flight-incapable) aphids to investigate effect of soybean cyst nematode infection of soybean on aphid performance. These studies had mixed results: in one set of experiments overall aphid population growth at 7 d was not statistically different between control and soybean cyst nematode-infected plants. A different experiment using a life-table analysis found that apterous aphids feeding on soybean cyst nematode-infected plants had significantly greater finite rate of increase (λ), intrinsic rate of increase (r(m)), and net reproductive rate (R(o)) compared with aphids reared on uninfected (control) soybean plants. We conclude that the below-ground herbivore, soybean cyst nematode, primarily influences soybean aphid behavior rather than performance.

Systemic lupus erythematosus complicated by acquired von Willebrand’s syndrome

Haematological abnormalities are common in systemic lupus erythematosus (SLE). In some cases of acquired von Willebrand syndrome (AvWS), von Willebrand disease (vWD) is associated with autoimmune or lymphoproliferative disorders. In this study, we describe a 36-year-old woman with SLE and AvWS. The patient was referred to our hospital because of easy bruisability and recurrent vaginal bleeding. She had no history of bleeding tendency and no family history of bleeding diathesis, but she had a history of recurrent arthralgia, photosensitivity and sicca symptoms. Tests for antinuclear, anti–double stranded DNA, anticardiolipin and anti–β2-glycoprotein I antibodies were all positive. Analysis of haemostatic parameters showed complete absence of von Willebrand factor ristocetin cofactor (vWF:Rco), von Willebrand antigen (vWF:Ag) and ristocetin-induced platelet aggregation (RIPA). Electrophoretic analysis of plasma showed a complete absence of high–molecular weight vWF multimer. The presence of antibody to vWF was detected by enzyme linked immunosorbent assay (ELISA). Treatment with corticosteroids improved SLE symptoms and corrected bleeding diasthesis. Also, the multimeric patterns of vWF became normalised and anti–vWF antibody disappeared. These findings indicated that this patient had SLE associated with AvWS, which was ameliorated by corticosteroid treatment.

Prevalence of narcolepsy-cataplexy in Korean adolescents

BACKGROUND

Narcolepsy typically begins between adolescence and early adulthood causing severe neuropsychiatric impairments, but few prevalence studies are available on adolescent narcoleptics. In the present study, we investigated the prevalence of narcolepsy-cataplexy in adolescents.

METHODS

In total 20,407 students, aged 14-19 years, participated in this study. Ullanlinna Narcolepsy Scale (UNS) was applied to all subjects and those with a UNS score of > or =14 were contacted by phone for semi-structured interview. Subjects then suspected of having narcolepsy participated in a laboratory investigation, which included polysomnography and HLA typing, or were interviewed in detail by telephone.

RESULTS

Three subjects were finally diagnosed as narcolepsy with cataplexy and seven subjects might be diagnosed as narcolepsy without cataplexy. Among three narcoleptics with cataplexy, two subjects were HLA-DQB1*0602 and DRB1*1501 positive, but one subject had no test of HLA typing. The prevalence of narcolepsy with cataplexy in Korean adolescence was thus determined to be 0.015% (95% confidence interval = 0.0-0.0313%).

CONCLUSION

This epidemiologic study is the first of its type on adolescent narcolepsy to use the International Classification of Sleep Disorders, 2nd edition (ICSD-2) diagnostic criteria. Considering those cases with an onset after adolescence were not included, the prevalence of narcolepsy with cataplexy determined in the present study is comparable with that of other studies in adults.

Arsenic removal by iron and manganese coated sand

In this study, as a promising technique for the treatment of both As(III) and As(V) at the same time in a single reactor, a column reactor containing both manganese-coated sand (MCS) and iron-coated sand (ICS), at different configuration of MCS and ICS, was used to treat wastewater contaminated with As(III). Prior to column experiments, batch experiments for the adsorption of As(V) by ICS were performed with variation of solution pH, ionic strength and types of background ions to investigate the effect of these parameters on the As(V) adsorption behaviour. As(V) adsorption onto ICS was quite similar with the variation of ionic strength by using NaNO3 as a background ion as well as in the presence of different types of background ions except phosphate. The adsorption curves shifted to the lower pH region with the increase of the initial arsenic concentration due to the finite number of adsorption sites on the ICS. For model prediction on the adsorption of As(V) onto ICS, the MINEQL program employing an inner-sphere complexation and a diffuse layer model was used. Model predictions generally agreed well with experimental results. From the column test, column system packed with equal ratio of MCS and ICS was identified as the best system due to a promising oxidation efficiency of As(III) to As(V) by MCS and adsorption of As(V) by both MCS and ICS.

Suitability of various turfgrass species and cultivars for development and survival of black cutworm (Lepidoptera: Noctuidae)

Black cutworm, Agrotis ipsilon (Hufnagel) (Lepidoptera: Noctuidae), feeding bioassays were conducted on young and mature turfgrass species to determine their potential resistance. Measures of resistance included larval weight, survival rate, instar development, pupal weight, duration of pupation, and days to pupation and adult emergence. Black cutworm reared on Poa pratensis 'Midnight', Poa arachnigera 'Tejas', and Poa pratensis X Poa arachnigera 'Reveille' exhibited slower development, lower weight, and higher overall mortality than those fed upon other turfgrasses tested. Larvae reared on Reveille did not survive to pupation and all died within 14 d. Black cutworm larvae reared on Midnight died within 17 d in trial 1 but attained pupation in trial 2. However, development of black cutworm larvae was slower on Poa pratensis Midnight compared with other susceptible turfgrass species such as Agrostis stolonifera 'Penncross', Poa annua ('DW194', 'Q98-4-6', and 'Q98-6-18'), Lolium perenne, and Poa supina 'Supranova'. Generally, larval performance on young plant tissues was better than on mature plant tissues. Larvae reared on P. pratensis 'Midnight' exhibited the most distinctive difference on young versus mature plant tissue. These results suggest that plant age may play an important role in turfgrass susceptibility and resistance.

Surgical resection of cavernous angiomas located in eloquent areas--clinical research

BACKGROUND

In patients with lesions at the eloquent areas, the aim of surgical interventions should be a more radical removal of the lesions with preservation of brain function. In this retrospective study, our techniques for localizing lesion and the postoperative results of 26 patients with cavernous angiomas (CA) located at the eloquent areas are summarized.

METHOD

The MR based 3D-rendering images were reconstructed from the 2D MR images by using a computerized program. These images were obtained in all patients for the localization of their lesion. Following craniotomy, to verify the actual location of lesions, we compared the 3D-image to the exposed cortical surface. Simultaneously, intraoperative ultrasonogram (IOUS) was used for the accurate localization of the lesion. In order to minimize the damage to the eloquent area, the minimal corticotomy was planned at the margin of the sulcus nearest to the lesion.

FINDINGS

An accurate localization of the lesion was possible in all 26 patients and the eloquent areas near the lesions were identified on the operation field. Complete removal of the CAs was done in all cases. One patient developed temporary monoparesis postoperatively, but the patient fully recovered in a month. Fourteen patients presented with preoperative seizures, and all patients had excellent seizure outcome after their surgery. The mean duration of the follow-up period was 27 months.

CONCLUSIONS

We could localize the lesion accurately using MRI 3D-rendering images and IOUS during the operation for CA. We planned minimal corticotomy to the lesion and we completely removed the lesion without causing any additional neurological deficit. Although CA can be located in eloquent areas, surgical removal of these lesions is a safe and effective treatment option for lowering the risk of developing symptoms and controlling the seizure.

Single-stage operation for bilateral middle cerebral artery aneurysms

BACKGROUND

Subarachnoid haemorrhage with bilateral middle cerebral artery aneurysms is occasionally encountered in neurosurgical practice. We report upon our experiences of the single-stage operation for bilateral middle cerebral artery aneurysms (BMCA) through a bilateral subfrontal approach.

METHODS

During the past two and half years, we have experienced three cases of BMCAA, who were treated by this method. The whole procedure was conducted using a single-stage head positioning and draping. Slight table tilting was enough to allow the proper clipping of each aneurysm.

FINDINGS

During the past 2.5 years, 255 cases of intracranial aneurysm have been treated in our hospital. Among these, the incidence of BMCAA was 1.18% (3/255). The mean duration of operation for the three cases involved was 5.8 hours, and showed a progressive decrease with experience. All patients recovered well, and were discharged as in other uneventful aneurysm cases. The total operation time was longer, and was a little more laborious than normal single aneurysm surgery.

CONCLUSION

This method has substantial advantages over "classical" skull base approaches to MCA aneurysms. As extensive frontal lobe manipulation and external facial incisions are avoided with subfrontal approaches, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced.

Comparison of sticky wing and cone pheromone traps for monitoring seasonal abundance of black cutworm adults and larvae on golf courses

Black cutworm, Agrotis ipsilon (Hufnagel) (Lepidoptera: Noctuidae), flight activity was monitored on three golf courses in Wisconsin by using two types of pheromone traps: the Texas cone trap and sticky wing trap. The Texas cone trap caught significantly more black cutworm males compared with the sticky wing trap, capturing almost 12-fold more males. Black cutworm males were most abundant during mid-July in 2001 and 2002, between 700 and 800 cumulative degree-days. Flight activity also was detected in early May and mid-August, but these peaks were not as pronounced as in mid-July. No definitive relationship between black cutworm flight activity and subsequent larval infestations on golf course putting greens occurred.

Organic and detergent degradation in combined O3/UF for domestic laundry wastewater reclamation

This paper focuses on the evaluation of organic and detergent degradation in a combined Ozone/UF system for domestic laundry wastewater reclamation. Formation of by-product was investigated by GC/MS for the reclaimed water. Ozone was injected into the raw wastewater in a 10 L contact tank and the wastewater was circulated through the membrane module for inner pressurized cross-flow filtration. The concentrate was returned back to the contact tank. The membrane used in this experiment was hollow fiber polysulfone UF membrane with MWCO 10,000. It has an effective filtration area of 0.06 m2. The experiment was carried out with intermittent ozone injection, 5 min injection and 10 min idling. Ozone was dosed at the concentration of 1.5 mg/L. The flux of the UF could be maintained at 0.24 m/d under filtration pressure 40-45 kPa and water temperature, 20-22 degrees C. The organic removal efficiency by the system was 90% in terms of COD. Ozone was considerably effective to degrade organics in the wastewater. Molecular weight of organics in the raw waste was mostly greater than 10,000 (72% of 950 mgCOD/L). However 86% of effluent COD (94-100 mg/L) was composed of organics smaller than MWCO 500 by ozone injection. No harmful by-products by ozone contact were detected from the analysis of treated water using GC/MS. It was identified that residual organics in the treated water were 1,1'-Oxybisbenzene, Octadecanoic acid, Squalene and Benzenmethanol, etc., which were additives contained originally in the detergent. Consequently the reclaimed water quality could be estimated safe enough to recycle for the rinsing cycle in a washing machine.

Spinal subdural haematoma as a complication of cranial surgery

BACKGROUND

Spinal subdural haematoma is a rare condition usually associated with several precipitating factors including coagulopathy, lumbar puncture, trauma, vascular malformation and previous spinal surgery. In this paper we report spinal subdural haematoma related to cranial surgery which is a previously unknown precipitating factor.

METHODS

The medical records of six patients in whom spinal subdural haematoma developed after cranial surgery was reviewed retrospectively for clinical presentation, radiological findings, treatment, and outcome.

FINDINGS

Six patients presented with low back pain and radiculopathy in the lower extremity after surgery for intracranial lesions. Symptom onset was between 2 and 9 days after cranial surgery. Initial cranial procedures were craniotomy and tumour removal in 1 patient, clipping of aneurysm in 1, temporal lobectomy for epilepsy in 4. None of the patients had previously known precipitating factors for spinal subdural haematoma. In all of them, the diagnosis was confirmed by magnetic resonance (MR) imaging and the spinal segment involved was the lower lumbar and sacral level except for one patient with a wide distribution of haematoma over the thoracolumbar region. All patients recovered completely without surgical intervention.

INTERPRETATION

Spinal subdural haematoma is a rare but possible complication of cranial surgery. It should be considered in patients with back pain and radiculopathy in the lower extremity developing after surgery for intracranial lesions. Unlike spontaneous spinal subdural haematoma with other precipitating factors, spinal subdural haematoma developing after cranial surgery takes a benign clinical course and resolves spontaneously over several days to 2 weeks without surgical intervention.

Lipopolysaccharide and CpG DNA synergize for tumor necrosis factor-alpha production through activation of NF-kappaB

Unmethylated CpG motifs in bacterial DNA (CpG DNA) activate host innate immune responses synergistically with some other microbial products, such as endotoxins, and may contribute to disease pathogenesis through excessive production of proinflammatory cytokines. Because monocyte-derived tumor necrosis factor (TNF)-alpha is an important mediator of disease, we investigated whether CpG DNA and lipopolysaccharide (LPS) synergize for inducing TNF-alpha biosynthesis. CpG DNA and LPS synergistically induce TNF-alpha production in RAW264.7 cells and J774 cells through activation of NF-kappaB. Furthermore, transient transfection with a super-repressive mutant of IkappaBalpha (IkappaBalpha-AA) demonstrated that NF-kappaB plays a critical role in CpG DNA-mediated TNF-alpha expression. Like NF-kappaB activation, CpG DNA-induced activation of mitogen-activated protein kinases (MAPK) regulates TNF-alpha production. Both extracellular receptor kinase (ERK) and p38 can regulate TNF-alpha gene transcription induced by CpG DNA. Although CpG DNA at the higher concentration slightly enhanced LPS-mediated phosphorylation of ERK, it did not alter the LPS-mediated activation of c-Jun N-terminal kinase and p38. In addition, CpG DNA showed little or no enhancement of LPS-mediated AP-1 activation. These results suggest that CpG DNA- and LPS-mediated signals converge at or above the level of NF-kappaB and ERK, and that there are distinct, as well as common, signaling pathways which are utilized by both CpG DNA and LPS for activating various transcription factors and MAPK.

Expression of interleukin-1 beta in lipopolysaccharide stimulated monocytes derived from patients with aneurysmal subarachnoid hemorrhage is correlated with cerebral vasospasm

Cerebral arterial vasospasm is a frequent complication after aneurysmal subarachnoid hemorrhage (SAH). Immunological activation may affect the development of vasospasm. This study measured the cytokines released from lipopolysaccharide-stimulated monocytes of SAH patients. We measured cerebral artery diameters before and after surgery for SAH. The activation index of interleukin-1 beta (IL-1 beta), but not tumor necrosis factor-alpha (TNF-alpha), was higher in patients with symptomatic vasospasm (5.6+/-1.7; n=11) than in patients without (1.8+/-0.4; n=11) (P=0.039). Furthermore, the IL-1 beta activation index was correlated with the degree of the postoperative angiographic vasospasm (correlation coefficient=-0.66, P=0.007). Individual variation in systemic immune activation, measured by monocyte-derived IL-1 beta expression levels after stimulation, may be associated with the development of vasospasm after aneurysmal SAH.

Increased burst firing in substantia nigra pars reticulata neurons and enhanced response to selective D2 agonist in hemiparkinsonian rats after repeated administration of apomorphine

Intermittent administrations of dopaminergic agents in hemiparkinsonian rat enhances the behavioral response to subsequent administration of the drugs. This phenomenon is known as "priming" and thought as comparable to drug-induced dyskinesia in patients with Parkinson's disease. We investigated the behavioral and electrophysiological changes in 6-hydroxydopamine (6-OHDA)-lesioned hemiparkinsonian rats after repeated administrations of apomorphine. Administration of apomorphine (0.32 mg/kg, intraperitoneal, i.p.) twice daily for 6 days enhanced the rotation induced by apomorphine from 341 turns/hour at the beginning to 755 turns/hr at the end. At the same time, the response to selective D2 agonist quinpirole (0.26 mg/kg, i.p.) was also enhanced from 203 to 555 turns/hr. Extracellular single unit recording revealed no significant difference in the basal firing rates of substantia nigra pars reticulata (SNr) neurons between the ipsilateral and contralateral side of the 6-OHDA lesion regardless of the repeated administrations of apomorphine. In SNr of the lesion side, the units with burst firing pattern were found more frequently after repeated administrations of apomorphine and the suppressive effect of quinpirole on the firing rate was enhanced. These findings suggest that the increased percentage of the burst units is the important electrophysiological change in the development of enhanced response to selective D2 agonist.

Clinical significance of molecular genetic changes in sporadic invasive pituitary adenomas

Several molecular and genetic changes have been found in pituitary adenomas. We looked for correlations between these changes and the degree of invasiveness of the tumors. The invasiveness of 11 pituitary adenomas was graded by Hardy classification. We examined the retinoblastoma gene (RB1.20 on chromosome 13q) and the region around the MEN1 locus (chromosome 11q13.1-5) for loss of heterozygosity. Also examined are p53 mutations using single strain conformation polymorphism, p53 protein overexpression using immuno cytochemistry, homozygous deletions of p15 and p16 by polymerase chain reaction, and cellular proliferative activity using MIB-1 antibody. Six tumors (54.5%) had an LOH at either RB1.20 or the MEN1 locus. LOHs were found more frequently in Grade 4 and stage E tumors (72% and 67%) than in Grade 3 and stage D tumors (25% and 40%). However, no mutation or overexpression of p53 was found. No homozygous deletions of p15 or p16 were identified. The cell proliferative index ranged from 0 to 3%. LOH at 11q13 and 13q may be valuable in predicting the invasiveness of pituitary adenomas.

Rubbing-induced molecular reorientation on an alignment surface of an aromatic polyimide containing cyanobiphenyl side chains

Surface lamellar decoration (SLD), surface enhanced Raman scattering (SERS) and optical second harmonic generation (SHG) experiments have been utilized to study the molecular orientation and conformation changes at a rubbed polyimide alignment-layer surface. This aromatic polyimide containing pendent cyanobiphenyl mesogens was synthesized via a polycondensation of 2,2'-bis(3,4-dicarboxy-phenyl)hexafluoropropane dianhydride (6FDA) with bis[omega-[4-(4-cyanophenyl)phenoxy]hexyl] 4,4'-diamino-2,2'-biphenyldicarboxylate (nCBBP, n = 6), abbreviated as 6FDA--6CBBP. Uniform alignment layers, possessing high pretilt angles ranging from 39 degrees to 43 degrees, have been achieved after mechanical rubbing of the polyimide thin film surface at room temperature and subsequent annealing. This is the first time that high pretilt angles have been detected to possess a negative angle (-theta(c)) with respect to the rubbing direction (i.e., opposite to the rubbing direction), considerably different from the conventional pretilt angle (theta(c)) observed along the rubbing direction. This observation is confirmed using magnetic null and SHG methods. Combined polyethylene (PE) SLD and atomic force microscopy experiments reveal that the azimuthal orientation distribution of the long axis of the edge-on PE lamellar crystals is oriented normal to the rubbing direction, indicating that the PE chains are aligned parallel to the rubbing direction. This SLD technique probes the anisotropic surface orientation of the outermost molecules of the rubbed polyimide layer. The SERS results show that prior to rubbing the surface, both the pendent cyanobiphenyls in the side chains and backbones possess nearly planar chain conformations at the polyimide surface. Mechanical rubbing causes not only tilting of the backbone moieties, such as imide-phenylene structure, but also significant conformational rearrangements of the pendent side chains at the surfaces. The molecular mechanism of this unusual alignment is due to the fact that the pendent cyanobiphenyls forms a uniformly tilted conformation on the rubbed surface, and the polar cyano groups point down toward the layer surface deduced from SHG phase measurements. This conformational rearrangement of the side chains results in the formation of fold-like bent structures on the surface, which directly leads to the long axis of cyanobiphenyls having the -theta(c) pretilt angle with respect to the rubbing direction.

Cervical positioning for reduction of sleep-disordered breathing in mild-to-moderate OSAS

The objective of this study was to assess whether cervical positioning could improve mild to moderate cases of the obstructive sleep apnea syndrome (OSAS). Eighteen subjects recruited from a tertiary sleep disorders clinic population with mild to moderate cases of OSAS were evaluated using a custom-fitted cervical pillow designed to increase upper airway caliber by promoting head extension. The subjects used their usual pillows during two consecutive recorded baseline nights in our laboratory. They then used the cervical pillow for 5 days at home and returned for 2 consecutive recorded nights at our laboratory to use the cervical pillow. During the nights in our laboratory, the subjects completed questionnaires, were videotaped to record head and body position, and had full polysomnography. The subjects had a significant trend toward improvement in their respiratory disturbance indices with use of the cervical pillow, despite spending more time in the supine position and having similar amounts of REM sleep in the baseline and experimental conditions. They also had nonsignificant trends toward improvements in their sleep efficiency and subjective depth of their sleep as well as significantly fewer arousals and awakenings in the experimental compared with the baseline condition. We propose that cervical positioning (i.e., head extension) with a custom-fitted cervical pillow provides a simple, noninvasive, and comfortable means of reducing sleep-disordered breathing in patients with mild to moderate OSAS.

Orientations of side chains and adsorbed liquid crystal molecules on a rubbed polyimide surface studied by optical second harmonic generation

Surface second harmonic generation was used to obtain approximate orientational distributions of the side chains and the adsorbed liquid crystal (LC) molecules on a rubbed side-chain polyimide surface. Both the side chains and the LC molecules appear to be well aligned in the rubbing direction but tilted away from the surface in the antirubbing direction. The latter yields a negative pretilt angle in a homogeneously aligned LC film sandwiched between two such surfaces. The side chains and the LC molecules, however, have antiparallel orientations at the surface.

Surgical tactics and outcome of treatment in jugular foramen schwannomas

Seven patients with schwannomas of the jugular foramen were included our study in Samsung Medical Center between 1995 and 1999. Patients with neurofibromatosis were excluded. The records of the seven patients (six surgical case and one nonsurgical case) were retrospectively reviewed. There were six women and one man (mean age, 47 years) with a symptom duration ranging from 3 months to 14 years (mean, 47 months). The predominant symptoms were hearing difficulty, hemifacial spasm and hoarseness. Preoperative audiologic evaluation, computerised tomography (CT), magnetic resonance (MR) imaging, and angiography were performed in most patients. We classified tumours into four types using Kaye and Pellet classification on the basis of radiological and surgical findings. The tumours were: Type A (at cerebellopontine angle) in one; Type B (foraminal) in two; Type C (extracranial and/or foraminal) in two; and Type D (intra- and extracranial) in two cases. We used various surgical approaches such as retrosigmoid suboccipital craniectomy for Type A tumours, infratemporal fossa type A approach (ITFA) for Type C tumours, petro-occipital transsigmoid approach or modified transcochear approach for Type D tumours and ITFA with partial labyrinthectomy for Type B. In the selection of surgical approaches, we took consideration of tumour extension, tumour size, and preoperative hearing function. Facial nerve transposition was not used only in one case of ITFA because of small tumour size (1.5cm). Gross total removal was achieved in five cases, and subtotal removal in one case (Type D tumour) with a single-stage operation. Stereotactic radiosurgery was performed on residual mass in the subtotally removed case. Follow-up period ranged from 13 to 49 months (mean, 27.5 months). There was neither postoperative mortality nor recurrence on follow-up MR imaging. There were two cases of temporary facial nerve palsy and one aggravation of pre-existing low cranial palsy. Two case of sustained vocal cord palsy underwent thyroplasty, but there was no aspiration pneumonia. Persistent cerebrospinal fluid collection was improved with lumboperitoneal shunt. The surgical approaches of each case should be tailored according to their shape and the clinical manifestation. We obtain acceptable outcomes from one-stage operation.

Chronic exposure to ELF magnetic fields during night sleep with electric sheet: effects on diurnal melatonin rhythms in men

The possible effects of repeated night-time exposure to an extremely low frequency magnetic field (ELF-MF) on melatonin were investigated in nine healthy male subjects aged 23-37 yr. The 16-week experiment consisted of 3 weeks of pre-exposure, 11 weeks of night-time exposure to MF generated from a nonheated electric sheet (ES), and 2 weeks of post-exposure recovery observation. The average MF intensity (rms, mainly 50 Hz AC) on the surface of the sheet was 0.7 microT at the head, 8.3 microT at the waist, and 3.5 microT at the feet of the subject. For each of the urine samples collected 5 times a day on scheduled sampling days, the urinary excretion rate (ng/h) of melatonin was determined, and 24 h rhythms were extracted for each subject and each experimental period (pre-exposure, first half and latter half exposure, and post-exposure periods) by the method of complex cosine curve fitting. Although estimates of the peak height, acrophase, and total daily amount of melatonin were characterized by significant variations among individual subjects, they did not reveal any statistically significant difference between exposure periods and nonexposure periods. Thus, the present study indicates that any profound effect of the MF originating from an ES on nocturnal melatonin production and its circadian rhythm is unlikely.

Surgical treatment of intractable epilepsy accompanying cortical dysplasia

OBJECT

Surgical treatment of cortical dysplasia (CD) together with intractable seizures is challenging because both visualization and localization of the lesion are difficult, correlation with seizure foci requires comprehensive study, and the surgical outcomes reported thus far are unsatisfactory. The authors report their experience in the surgical treatment of CD classified according to a surgical point of view.

METHODS

The definition of CD used in this study was a dysplastic lesion visible on magnetic resonance (MR) images or a lesion that, although not visible on MR images, was diagnosed as moderate-to-severe dysplasia by using pathological analysis. During the last 4.5 years, the authors treated 36 patients with intractable epilepsy accompanied by CD. They divided the 36 cases of CD into four characteristic groups: Group A, diffuse bilateral hemispheric dysplasia; Group B, diffuse lobar dysplasia; Group C, focal dysplasia; and Group D, a moderate to severe degree of CD with a normal appearance on MR images. All but one patient in Group C were monitored in the epilepsy monitoring unit by using subdural electrodes for seizure localization and functional mapping. The incidence of CD among a cohort of 291 patients who had undergone epilepsy surgery at the authors' center during the study period was 12.4%. The mean age of the 36 patients was 21.3 years and the mean age at seizure onset was 8.5 years. The mean follow-up period was 26 months. Twenty-six patients (72.2%) belonged to Engel Class I or II (20 and six, respectively). There were five cases in Group A, nine in Group B, nine in Group C, and 13 in Group D. Patients in Groups A and B were significantly younger at seizure onset and had significantly poorer surgical outcomes compared with patients in Groups C and D (p < 0.05). If outcome is compared on the basis of the extent of removal of CD, patients in whom CD was completely removed had significantly better outcomes than those in whom CD was only partially removed (p < 0.001).

CONCLUSIONS

The authors conclude that intractable epilepsy accompanied by CD can be treated surgically using comprehensive preoperative approaches. Deliberate resective procedures aimed at complete removal of dysplastic tissue ensure excellent seizure control without permanent neurological deficit.

Nonlinear optical studies of liquid crystal alignment on a rubbed polyvinyl alcohol surface

Sum-frequency vibrational spectroscopy and second-harmonic generation have been used to measure the orientational distributions of the polymer chains and adsorbed 8CB liquid crystal molecules on a rubbed polyvinyl alcohol surface. Results show that the polymer chains at the surface appear to be well aligned by rubbing, and the adsorbed liquid crystal molecules are aligned, in turn, by the surface polymer chains. Strong correlation exists between the orientational distributions of the polymer chains and the liquid crystal molecules, indicating that the surface-induced bulk alignment of a liquid crystal film by rubbed polymer surfaces is via an orientational epitaxylike mechanism.

Seroprevalence of toxoplasmosis in the residents of Cheju island, Korea

This study was performed to evaluate the epidemiological status of toxoplasmosis among the residents of Cheju island. The sera of local students from 18 high schools (boys 2110, girls 2460) and those of adults (474 admitted to Cheju Chungang General Hospital) were collected and checked for the IgG antibody titers against Toxoplasma gondii. Serum samples collected from both the students and adults showed sero-positive rate of 5.5% and 12.9%, respectively. Although the rates were not significantly different between the sexes (5.4% for the boys and 5.5% for the girls attending school), the geographical difference showed a significant difference between the urban (4.6-6.9%) and rural areas (5.6-8.8%) (p < 0.05). Based on the high positive rates, it should be necessary to control toxoplasmosis in Cheju island.

Vascular endothelial growth factor expression under ischemic stress in human meningiomas

Vascular endothelial growth factor (VEGF) is an endothelial cell-specific antigen and angiogenic factor that plays a role in angiogenesis. We analyzed the expression of four VEGF mRNA isoforms in meningiomas. Among 35 meningiomas, 11 came from patients who underwent complete (n=4) or partial (n=7206=189 in all samples. However, the VEGF121 and 165 isoforms were significantly upregulated in samples from patients who underwent partial preoperative embolization. The diffusible VEGF121 isoform may be important for vascularity and edema formation in meningiomas.

Anterior distribution of human olfactory epithelium

OBJECTIVES/HYPOTHESIS

To functionally investigate the distribution of the olfactory epithelium in humans by means of the electro-olfactogram (EOG) and anatomically located biopsy specimens.

STUDY DESIGN

Prospective, nonrandomized, investigational.

METHODS

Supra-threshold EOG recordings were made on 12 healthy, trained volunteers (6 women, 6 men; age range, 21-48 y). Vanillin was used as the stimulus, since it exclusively excites olfactory receptor neurons. The EOG was recorded with tubular electrodes that were placed using thin-fiber endoscopic guidance. Biopsy specimens were obtained of anterosuperior nasal cavity mucosa in the same regions as the positive EOGs in 15 smell-tested patients (7 women, 8 men; age range, 22-60 y) during routine nasal and sinus surgery. This biopsied tissue was histologically processed and stained for olfactory and neural proteins.

RESULTS

Viable responses to EOG testing were obtained in 7 of 12 subjects. In these seven subjects it was possible to identify nine sites above or below the anterior middle turbinate insertion where EOGs were obtained. The biopsy results showed mature olfactory receptor neurons in this same area.

CONCLUSIONS

Human olfactory epithelium appears to be distributed more anteriorly than previously assumed.

Mapping of functional organization in human visual cortex: electrical cortical stimulation

OBJECTIVES

To investigate the pattern of functional organization in the human visual cortex through electrical cortical stimulation.

METHODS

Electrical cortical stimulation was applied to the occipital cortex and adjacent cortices using subdural grid electrodes in 23 epilepsy patients. Diverse visual responses were recorded. These responses were divided into different categories according to the specific response modalities, such as form, color, and motion. Form visual responses were further subdivided into simple, intermediate, and complex responses. The cortical localization of subdural electrodes was identified using MRI-CT coregistration. The cortical distribution of different visual responses was projected into three-dimensional surface renderings of the brain. The distribution and frequency of subdural electrodes showing different visual responses were quantified by calculating the percentage of the number of electrodes showing one specific type of visual response at the corresponding anatomic region to the total number of electrodes in all brain regions that produced the same response.

RESULTS

Simple form responses were obtained mostly at the occipital pole and the inferior occipital gyrus (47.4%) and the striate cortex (42.4%). Intermediate form responses occurred mainly on the peristriate cortex (52.5%) and the lateral occipital (28.0%) and fusiform gyri (19.5%). Complex forms were produced by stimulation of the basal temporo-occipital region (57.6%) and the lateral temporal or lateral temporo-occipital junctional region (42.4%). Color responses occurred on the basal occipital area, mostly at the fusiform (40.0%) and lingual gyri (36.0%). Moving sensations were evoked by stimulation of the basal temporo-occipital (28.4%) and the mesial parieto-occipital or temporo-parieto-occipital junctional regions (23.9%).

CONCLUSIONS

Different modalities of vision, such as form, color, and moving sensation, appeared to be distributed and organized in different areas of the human visual cortex.

Spider mite allergy in apple-cultivating farmers: European red mite (Panonychus ulmi) and two-spotted spider mite (Tetranychus urticae) may be important allergens in the development of work-related asthma and rhinitis symptoms

BACKGROUND

Recent investigations have suggested that the citrus red mite (Panonychus citri) is the most important allergen affecting citrus-cultivating farmers with asthma, allergic rhinitis, or both.

OBJECTIVE

We sought to evaluate type I hypersensitivity to spider mites, particularly the European red mite (Panonychus ulmi) and the two-spotted spider mite (Tetranychus urticae), and to determine the relationship between hypersensitivity to spider mites and respiratory dysfunction.

METHODS

We performed a cross-sectional survey. Questionnaires were given, and skin prick tests for 11 inhalant allergens common in Korea and 2 species of spider mites (European red mite and two-spotted spider mite) were performed in 725 apple-cultivating farmers in Korea.

RESULTS

Results of skin prick tests in the apple farmers indicated that European red mite (23.2%) was the most common sensitizing allergen, followed by Tyrophagus putrescentiae (21.2%), two-spotted spider mite (16.6%), Dermatophagoides farinae (16.3%), D pteronyssinus (14.4%), cockroach (13.1%), and Hop Japanese (Humulus Japonicus) pollen (12.0%). Positive skin responses (mean wheal size >/=3 mm) to one or more of 13 inhalant allergens were found in 48.2% of farmers tested, whereas 40 subjects (8.6%) had an isolated skin response to the spider mites. Among 119 farmers with work-related asthmatic symptoms, the positive skin response rates to European red mite and two-spotted spider mite were 40.4% and 27.0%, respectively. These figures were significantly higher than those found among farmers without work-related symptoms (19.1% and 14.1%, respectively; P <.01). The prevalence of work-related asthma symptoms was higher in farmers with positive skin responses to spider mites than in those with negative skin responses to spider mites and those with positive skin responses to any allergen tested (31.4% vs 15.0% vs 21.0%, respectively; P <.05).

CONCLUSION

Spider mites, particularly European red mite and 2-spotted spider mite, are common sensitizing allergens in apple-cultivating farmers. These spider mites may be important causative allergens in the development of work-related respiratory symptoms in these workers.

White-matter change in mesial temporal sclerosis: correlation of MRI with PET, pathology, and clinical features

PURPOSE

To assess the magnetic resonance imaging (MRI), positron emission tomography (PET), pathology, and clinical findings of patients with the MRI feature of white-matter change (WMC) in the anterior temporal lobe.

METHODS

Fifty-six patients with pathologically proven mesial temporal sclerosis were included in this study. MRI and 18F-2-deoxyglucose-(FDG) PET images were obtained before surgery in all patients. The patients were divided into two groups according to the presence of WMC on their MRI. WMC consists of an indistinct gray-white matter demarcation and an increased signal intensity of the anterior temporal lobe on T2-weighted images. The two groups were then compared in terms of MRI, PET, pathology, and clinical features.

RESULTS

The MRI feature of WMC was observed in 18 (32%) of the 56 patients. PET images of those patients revealed more severe hypometabolism of the ipsilateral temporal lobes (p< 0.05). In terms of histologic findings, larger numbers of heterotopic neurons were observed in the anterior temporal lobe white matter of these patients who also shared the following clinical features: earlier seizure onset, frequent history of febrile convulsions, and favorable surgical outcomes.

CONCLUSIONS

The MRI feature of WMC is an additive sign for correct seizure lateralization and may be related to a favorable surgical outcome in patients with temporal lobe epilepsy.

Antidepressant-induced bruxism successfully treated with gabapentin

BACKGROUND

Symptoms consistent with bruxism are a common chief complaint in dental practice. The authors describe a case of bruxism likely induced by the antidepressant venlafaxine and successfully treated with gabapentin.

CASE DESCRIPTION

A case of bruxism, anxiety, insomnia and tremor is reported in a man with bipolar disorder that developed a few days after he initiated venlafaxine therapy for depression. The patient's psychiatrist prescribed gabapentin for anxiety symptoms, and shortly thereafter the man experienced a complete resolution of the bruxism.

CLINICAL IMPLICATIONS

On the basis of this case and the available literature, the authors conclude that bruxism secondary to antidepressant therapy may be common. Thus, dentists should inquire about the use of these medications in patients who have bruxism. Gabapentin may offer promise in the treatment of this condition.

Relation between CT scan findings and human sense of smell

Symptom questionnaires were obtained from 106 patients immediately before nasal and sinus computed tomography scans at the Johns Hopkins Outpatient Center. Their scans were analyzed by two otolaryngologists and three neuroradiologists by using a semiobjective rating system of the size and opacity of 36 anatomic areas. Patients estimated their own left and right sense of smell as excellent, diminished, or absent. Results of the data are as follows: (1) There is no correlation between smell ability and size of the nasal and sinus structures. This indicates that there is no gross effect of the bulging of sinuses into the nasal airway; (2) As a rule, opacity of only left-sided anatomic structures was correlated with both left and right sense of smell (p < 0.01). This suggests that our subjects were using their left smell receptors preferentially, to the exclusion of and in place of the right smell receptors; and (3) Total, not partial, opacity of the left olfactory cleft, frontal recess, or ethmoidal infundibulum was correlated with decreased sense of smell. This suggests that these anterior structures in the region of the olfactory cleft do affect airflow, but complete obstruction of these spaces is needed. Possible explanations for the effect of opacified sinuses on the sense of smell include (1) The presence of fluid or thickened mucosa in the sinuses may interfere with perceived olfactory ability by changing nasal airflow patterns or odorant access to receptors; (2) There may be olfactory receptors inside the sinuses; and (3) There may be a relation between the trigeminal receptors in the sinuses and the olfactory system.

Signalling initiated with CD4-TCR or TCR-TCR interactions: comparison of tyrosine phosphorylation patterns and CD45 effects

Antigen-triggered response in T cells is mediated by the T cell receptor (TCR)/CD3-complex. This signalling, however, is modulated by a number of other surface molecules. Among the most important of these is the CD4/CD8 molecule which associates with the TCR/CD3-complex and binds to the MHC complex. The molecular mechanisms involved in interactions between TCR-TCR and TCR-CD4 are not fully understood. We have earlier described an experimental model that allows us to dissect signals involving CD4-TCR interactions and those involving TCR-TCR interactions using a mouse CD4-CD8- T cell hybridoma cell-line transfected either with the TCR from a mouse T-helper 2 cell-line (D10) alone or with both the TCR and the CD4 molecule. To further characterize these two different modes of signalling in T lymphocytes we have studied the tyrosine phosphorylation patterns resulting from these interactions. In addition, we have studied the modulatory effect of the CD45 molecule on these interactions. In contrast to some earlier reports, we found that both the patterns of induced tyrosine phosphorylation and the effects of CD45 modulation were essentially similar in the CD4-TCR and the TCR-TCR signal transduction cascades. The results are consistent with a purely synergistically amplifying function for CD4 on the TCR-mediated signalling.