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Enomoto K, Sho M, Wakatsuki K, Takayama T, Matsumoto S, Nakamura S, Akahori T, Tanaka T, Migita K, Ito M, Nakajima Y. Prognostic importance of tumour-infiltrating memory T cells in oesophageal squamous cell carcinoma. Clin Exp Immunol 2012; 168:186-91. [PMID: 22471279 DOI: 10.1111/j.1365-2249.2012.04565.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Memory T cells survive for many months and years and are critically important for host defence in humans. In tumour immunity, they have been also suggested to play a significant role in tumour progression and metastasis. However, the role of memory T cells in actual human cancer remains largely unknown. In this study, the clinical importance of tumour-infiltrating CD45RO(+) memory T cells was investigated in human oesophageal squamous cell carcinoma (OSCC). CD45RO(+) T cells were evaluated by immunohistochemistry in primary OSCC tumours from 105 patients. Patients were classified into two groups as CD45RO(+hi) or CD45RO(+lo) based on the number of cells stained positively for CD45RO. No significant difference was observed between CD45RO status and several clinicopathological prognostic factors. However, the postoperative overall and disease-free survival for CD45RO(+hi) patients was significantly better than for CD45RO(+lo) patients. Furthermore, there were significant correlations of CD45RO status in the primary tumour with postoperative lymph node and pulmonary recurrence, suggesting that memory T cells may control postoperative metastatic recurrence. Most importantly, CD45RO(+) memory T cell status has a significant prognostic value for OSCC independently of conventional tumour-node-metastasis (TNM) classification. Our study may provide a rationale for developing a novel immunotherapy in intentional induction of memory T cells for the treatment of oesophageal cancer.
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Affiliation(s)
- K Enomoto
- Department of Surgery, Nara Medical University, Nara, Japan
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2
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Yamato I, Sho M, Nomi T, Akahori T, Shimada K, Hotta K, Kanehiro H, Konishi N, Yagita H, Nakajima Y. Clinical importance of B7-H3 expression in human pancreatic cancer. Br J Cancer 2009; 101:1709-16. [PMID: 19844235 PMCID: PMC2778545 DOI: 10.1038/sj.bjc.6605375] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: B7-H3 is a new member of the B7 ligand family and regulates T-cell responses in various conditions. However, the role of B7-H3 in tumour immunity is largely unknown. The purpose of this study was to evaluate the clinical significance of B7-H3 expression in human pancreatic cancer and the therapeutic potential for cancer immunotherapy. Methods: We investigated B7-H3 expression in 59 patients with pancreatic cancer by immunohistochemistry and real-time PCR. Furthermore, we examined the anti-tumour effect of B7-H3-blocking monoclonal antibody in vivo in a murine pancreatic cancer model. Results: Tumour-related B7-H3 expression was abundant in most human pancreatic cancer tissues and was significantly higher compared with that in non-cancer tissue or normal pancreas. Moreover, its expression was significantly more intense in cases with lymph node metastasis and advanced pathological stage. B7-H3 blockade promoted CD8+ T-cell infiltration into the tumour and induced a substantial anti-tumour effect on murine pancreatic cancer. In addition, the combination of gemcitabine with B7-H3 blockade showed a synergistic anti-tumour effect without overt toxicity. Conclusion: Our data show for the first time that B7-H3 may have a critical role in pancreatic cancer and provide the rationale for developing a novel cancer immunotherapy against this fatal disease.
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Affiliation(s)
- I Yamato
- Department of Surgery, Nara Medical University, Nara 634-8522, Japan
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3
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Boehlert C, Cowen C, Quast J, Akahori T, Niinomi M. Fatigue and wear evaluation of Ti-Al-Nb alloys for biomedical applications. Materials Science and Engineering: C 2008. [DOI: 10.1016/j.msec.2007.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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4
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Nomi T, Sho M, Akahori T, Kanehiro H, Nakajima Y. Protective effect of prostaglandin E2 receptors EP2 and EP4 in alloimmune response in vivo. Transplant Proc 2007; 38:3209-10. [PMID: 17175225 DOI: 10.1016/j.transproceed.2006.10.118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Indexed: 10/23/2022]
Abstract
Prostaglandin E2 (PGE2) is produced during inflammatory responses mediating a variety of both innate and adaptive immune responses through 4 distinct receptors: EP1 to EP4. The use of gene-targeted mice and selective agonists/antagonists responsible for each receptor has gradually revealed that each receptor plays a unique and important role in various disease conditions. In addition, PGE2 is known to have some immunosuppressive properties. In this study, we investigated the role of PGE2 receptors by examining the therapeutic efficacy of highly selective receptor agonists on the alloimmune response in vivo. We used a fully major histocompatibility complex (MHC)-mismatched murine cardiac transplantation model. C57BL/6 cardiac allografts were heterotopically transplanted into BALB/c recipients. We treated mice with a highly selective agonist for each EP receptor. EP2 and EP4 agonists significantly prolonged allograft survival compared with controls. In particular, the EP4 agonist was more effective than the EP2 agonist in the inhibition of acute allograft rejection. In conclusion, PGE2 receptors merit further study as novel therapeutics for clinical transplantation.
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MESH Headings
- Animals
- Heart Transplantation/immunology
- Histocompatibility Testing
- Male
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Receptors, Prostaglandin E/agonists
- Receptors, Prostaglandin E/immunology
- Receptors, Prostaglandin E/physiology
- Receptors, Prostaglandin E, EP2 Subtype
- Receptors, Prostaglandin E, EP4 Subtype
- Signal Transduction/immunology
- Transplantation, Homologous/immunology
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Affiliation(s)
- T Nomi
- Department of Surgery, Nara Medical University, Nara, Japan
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5
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Akahori T, Sho M, Kashizuka H, Nomi T, Kanehiro H, Nakajima Y. A novel CCR5/CXCR3 antagonist protects intestinal ischemia/reperfusion injury. Transplant Proc 2007; 38:3366-8. [PMID: 17175273 DOI: 10.1016/j.transproceed.2006.10.115] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Indexed: 11/19/2022]
Abstract
Chemokines and chemokine receptors have been demonstrated to be critical regulators in a variety of physiologic and pathologic immune responses. In particular, CCR5 and CXCR3 have been reported to play important roles in the alloimmune response. In this study, we investigated the therapeutic efficacy of a novel small-molecule compound, TAK779, an antagonist targeting both CCR5 and CXCR3 in intestinal ischemia/reperfusion (I/R) injury. We utilized an established murine intestinal I/R injury model. TAK779 treatment significantly improved mouse survival after 60 minutes of intestinal ischemia. We then examined the local intestinal expression of several cytokines and chemokines at 2 hours after reperfusion using real-time PCR. TAK779 treatment downregulated the expression of several cytokines, including TNF-alpha, IFN-gamma, and IL-4, suggesting that the beneficial effect of TAK779 was associated with inhibition of local immune activation. We further examined the systemic response after TAK779 treatment. Lung tissue damage was significantly prevented by the treatment, as determined by lung wet-to-dry weight ratios at 4 hours after intestinal I/R injury. In addition, we observed that CCR5 expression in the lung was significantly downregulated by the treatment, suggesting that TAK779 inhibited the infiltration of CCR5-positive cells into the remote organ. Our data suggest the critical role of CCR5 and CXCR3 in intestinal I/R injury and therapeutic efficacy of a novel small compound, TAK779, for protection against the intestinal I/R injury.
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Affiliation(s)
- T Akahori
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
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6
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Boehlert C, Cowen C, Jaeger C, Niinomi M, Akahori T. Tensile and fatigue evaluation of Ti–15Al–33Nb (at.%) and Ti–21Al–29Nb (at.%) alloys for biomedical applications. Materials Science and Engineering: C 2005. [DOI: 10.1016/j.msec.2004.12.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Li SJ, Niinomi M, Akahori T, Kasuga T, Yang R, Hao YL. Fatigue characteristics of bioactive glass-ceramic-coated Ti–29Nb–13Ta–4.6Zr for biomedical application. Biomaterials 2004; 25:3369-78. [PMID: 15020109 DOI: 10.1016/j.biomaterials.2003.09.108] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2003] [Accepted: 09/21/2003] [Indexed: 10/26/2022]
Abstract
A new surface-coating method by which CaP invert glass is used to improve the bioactivity of titanium alloys has been developed recently. In this method, the powder of CaP invert glass (CaO-P2O5-TiO2-Na2O) is coated on the surface of titanium alloy samples and heated between 1073 and 1123 K. With this treatment, a calcium phosphate layer mainly containing beta-Ca3(PO4)2 phase can be coated easily on titanium alloy samples. In the present study, the effect of this coating process on the fatigue properties of Ti-29Nb-13Ta-4.6Zr, a new metastable beta alloy for biomedical applications, has been investigated. The fatigue endurance limit of the coated alloy was found to be about 15% higher than that of uncoated alloy, as a result of the formation of a hard (alpha + beta) layer and a small amount of the omega phase during the coating process. The coating exhibits excellent adhesion to the substrate during the tensile and fatigue tests. Subsequent ageing at 673 K for 259.2 ks greatly improves the fatigue resistance of the coated alloy due to isothermal omega phase precipitation, and does not have obvious detrimental effect on the coating properties.
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Affiliation(s)
- S J Li
- Department of Production Systems Engineering, Toyohashi University of Technology, 1-1, Hibarigaoka, Tempaku-cho, Toyohashi 441-8580, Japan
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8
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Affiliation(s)
- Y. L. Zhou
- Department of Production Systems Engineering, Toyohashi University of Technology
| | - M. Niinomi
- Department of Production Systems Engineering, Toyohashi University of Technology
| | - T. Akahori
- Department of Production Systems Engineering, Toyohashi University of Technology
| | - Gunawarman
- Department of Production Systems Engineering, Toyohashi University of Technology
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Morioka Y, Akahori T, Hayaishi T, Namioka T, Sasaki T, Nakamura M. Coincidence spectra of threshold photoelectrons and ions near the C2Σu+state of N2+. ACTA ACUST UNITED AC 1999. [DOI: 10.1088/0022-3700/19/7/016] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Morioka Y, Watanabe M, Akahori T, Yagishita A, Nakamura M. Angular distributions of photoelectrons from the autoionising states between the2P3/2and2P1/2ionisation thresholds of Kr and Xe. ACTA ACUST UNITED AC 1999. [DOI: 10.1088/0022-3700/18/1/009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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11
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Abstract
Clinically apparent hematogenous skeletal muscle metastases from lung cancer are extremely rare. We present a 72-year-old man with a large cell lung carcinoma metastatic to nuchal muscle. Cervical computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a well-defined mass in the left splenius capitis muscle. A percutaneous needle biopsy was performed to establish a diagnosis. Localized skeletal muscle swelling may rarely prove to be metastases in patients with lung cancer, but should be investigated in the case of muscle swelling.
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Affiliation(s)
- M Nishikawa
- First Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
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12
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Akahori T, Morioka Y, Tanaka T, Yoshii H, Hayaishi T, Ito K. High resolution threshold photoelectron spectrum of oxygen in the 12–19 eV region. J Chem Phys 1997. [DOI: 10.1063/1.474849] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Akahori T, Yuzawa Y, Nishikawa K, Tamatani T, Kannagi R, Miyasaka M, Okada H, Hotta N, Matsuo S. Role of a sialyl Lewis(x)-like epitope selectively expressed on vascular endothelial cells in local skin inflammation of the rat. The Journal of Immunology 1997. [DOI: 10.4049/jimmunol.158.11.5384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
The role of the inducible L-selectin ligand was studied in complement-dependent acute dermatitis in rats. Although mAbs against typical sialyl Lewis(x) (CSLEX-1 and SNH-3) did not react with skin venules, a sialyl Lewis(x)-like epitope defined by mAb 2H5 (2H5-Ag) was de novo expressed on the endothelial cells of skin venules in the area of inflammation. Expression of 2H5-Ag increased concomitantly with the progression of inflammation. 2H5-Ag was identified at the 75-, 150-, and 180-kDa bands when inflammatory skin tissue was analyzed by Western blotting. In contrast, P- and E-selectins were not detectable. The role of 2H5-Ag in this model was studied in in vitro and in vivo methods. First, 2H5 was i.v. injected 15 min before induction of dermatitis. 2H5 bound to skin venules and significantly reduced the neutrophil infiltration and plasma protein leakage. In contrast, CSLEX-1, mAb ARP2-4 (P-selectin blocker), or mAb ARE-5 (E-selectin blocker) had no effects. Second, adhesion of isolated rat neutrophils to the inflammatory skin section was inhibited significantly when the sections, but not neutrophils, were preincubated with 2H5. Third, fluorescein-labeled normal rat neutrophils were injected into a rat 10 h after induction of dermatitis. The number of labeled neutrophils infiltrated into the inflammatory site was reduced significantly when they were preincubated with HRL-3 (blocking mAb against rat L-selectin), but not with 2H5 or HRL-4 (nonblocking mAb against rat L-selectin). These data show that de novo expressed 2H5-Ag/L-selectin adhesion pathway contributes to the development of acute complement-dependent inflammation in the skin.
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Affiliation(s)
- T Akahori
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
| | - Y Yuzawa
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
| | - K Nishikawa
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
| | - T Tamatani
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
| | - R Kannagi
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
| | - M Miyasaka
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
| | - H Okada
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
| | - N Hotta
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
| | - S Matsuo
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
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14
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Akahori T, Yuzawa Y, Nishikawa K, Tamatani T, Kannagi R, Miyasaka M, Okada H, Hotta N, Matsuo S. Role of a sialyl Lewis(x)-like epitope selectively expressed on vascular endothelial cells in local skin inflammation of the rat. J Immunol 1997; 158:5384-92. [PMID: 9164959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The role of the inducible L-selectin ligand was studied in complement-dependent acute dermatitis in rats. Although mAbs against typical sialyl Lewis(x) (CSLEX-1 and SNH-3) did not react with skin venules, a sialyl Lewis(x)-like epitope defined by mAb 2H5 (2H5-Ag) was de novo expressed on the endothelial cells of skin venules in the area of inflammation. Expression of 2H5-Ag increased concomitantly with the progression of inflammation. 2H5-Ag was identified at the 75-, 150-, and 180-kDa bands when inflammatory skin tissue was analyzed by Western blotting. In contrast, P- and E-selectins were not detectable. The role of 2H5-Ag in this model was studied in in vitro and in vivo methods. First, 2H5 was i.v. injected 15 min before induction of dermatitis. 2H5 bound to skin venules and significantly reduced the neutrophil infiltration and plasma protein leakage. In contrast, CSLEX-1, mAb ARP2-4 (P-selectin blocker), or mAb ARE-5 (E-selectin blocker) had no effects. Second, adhesion of isolated rat neutrophils to the inflammatory skin section was inhibited significantly when the sections, but not neutrophils, were preincubated with 2H5. Third, fluorescein-labeled normal rat neutrophils were injected into a rat 10 h after induction of dermatitis. The number of labeled neutrophils infiltrated into the inflammatory site was reduced significantly when they were preincubated with HRL-3 (blocking mAb against rat L-selectin), but not with 2H5 or HRL-4 (nonblocking mAb against rat L-selectin). These data show that de novo expressed 2H5-Ag/L-selectin adhesion pathway contributes to the development of acute complement-dependent inflammation in the skin.
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Affiliation(s)
- T Akahori
- The Third Department of Internal Medicine, Nagoya University School of Medicine, Showa-ku, Japan
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15
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Shirakawa T, Morimoto K, Sasaki S, Taniguchi K, Motonaga M, Akahori W, Akahori S, Akahori T, Ohmori H, Kuroda E, Okabe K, Yugari K, Yamana M. Effect of maternal lifestyle on cord blood IgE factor. Eur J Epidemiol 1997; 13:395-402. [PMID: 9258545 DOI: 10.1023/a:1007361013917] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
During recent decades much interest has been focused on the possibility of predicting and preventing atopic diseases during pregnancy. The idea of being able to detect a predisposition early and take suitable environmental measures in order to avoid overt allergy is an attractive position. Elevated cord IgE of around 1.0 IU/ml has been proposed as a predictor in western children. However, there remains no information about the effect of maternal lifestyle during pregnancy on these levels. Total IgE levels were therefore determined using Pharmacia CAP system and PRIST, with sensitivities of 0.01 kU/l and 0.25 kU/l, respectively, from serum samples taken from 1138 Japanese pairs of cord blood and pregnant women responding to a questionnaire regarding 17 health practices, intake of 32 food allergens and 5 environmental factors. Of these, 28 (2.5%) pairs of samples were excluded from further analysis because of high contamination of IgA (> 15.4 mg/ml) in cord blood. Median cord blood IgE was 0.286 kU/l and geometric mean IgE was 66.25 kU/l in maternal sera using CAP system; there was no significant correlation between maternal log (IgE) and cord blood IgE. Similar results were obtained from PRIST, whose correlation with CAP system was significant (r = 0.884, p < 0.001 for maternal and r = 0.765, p < 0.001 for cord blood). Multiple logistic analysis demonstrated that avoidance of simultaneous exposure to hens' eggs and cow's milk (relative risk = 1.3, p < 0.05) as well as soy beans (relative risk = 2.8, p < 0.01) should be advised to mothers with positive allergic histories and/or high total IgE (> 400 IU/ml), especially in women aged more than 35 years who are pregnant with a male child. However, maintenance of healthy lifestyles, especially taking proper exercise and sleeping, and avoidance of inhalant allergens during late pregnancy may be a more important strategy for the reduction of cord blood IgE levels.
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Affiliation(s)
- T Shirakawa
- Department of Hygiene and Preventive Medicine, School of Medicine, Osaka University, Japan
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16
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Suzuki M, Suzuki S, Akahori T, Miyashita A, Yoshioka T, Sato M, Okubo T. Patterns of inspiratory muscle shortening during hypoxia and hypercapnia in dogs. Eur Respir J 1997; 10:430-6. [PMID: 9042645 DOI: 10.1183/09031936.97.10020430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The shortening of parasternal intercostal muscles (Para) and crural (Cru) and costal diaphragms (Cos) are not precisely understood. We therefore examined shortening patterns of these inspiratory muscles by using chronically implanted sonomicrometers in dogs. To avoid acute effects of surgery, measurements were performed 3 weeks after implanting the sonomicrometers. Patterns of length changes of Para, Cru, and Cos were measured during hypoxia and hypercapnia under two levels of anaesthesia. Respiratory length change (delta L) was assessed as a percentage change relative to the resting length at functional residual capacity (LFRC). Peak tidal shortening was defined as the maximal change from LFRC (delta L/LFRC). Under light anesthesia, the delta L/LFRC was the same among the three muscle groups at all tidal volumes (VT). Under deep anaesthesia, the delta L/LFRC both of Cru and Cos exceeded that of Para. Under light anaesthesia, the maximal shortening velocity ((delta L/LFRC)/delta t) of Cru was greater than that of Para. Under deep anaesthesia, the (delta L/LFRC)/delta t of Para was exceeded by that both of Cru and Cos. Furthermore, the (delta L/LFRC)/delta t of each inspiratory muscle was greater during hypoxia than during hypercapnia at equal volume. We conclude that: 1) the contribution of the diaphragm to ventilation increases during deep anaesthesia; 2) the muscle shortening velocity during hypoxia or hypercapnia is lower in parasternal intercostal muscles than in the diaphragm; and 3) there is no difference in the shortening pattern between crural and costal diaphragms.
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Affiliation(s)
- M Suzuki
- First Department of Internal Medicine, Yokohama City University School of Medicine, Japan
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17
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Suzuki S, Akahori T, Miyazawa N, Numata M, Okubo T, Butler JP. Alveolar surface area-to-lung volume ratio in oleic acid-induced pulmonary edema. J Appl Physiol (1985) 1996; 80:742-6. [PMID: 8964731 DOI: 10.1152/jappl.1996.80.3.742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
It is unknown how the in vivo alveolar surface area-to-volume ratio (S/V) changes in low-pressure pulmonary edema. Here, the S/V is the area of the air-tissue interface per unit total volume (air plus tissue). We hypothesized that in oleic acid (OA)-induced edema inactivation of the pulmonary surfactant may increase surface tension and decrease the S/V at any given lung volume. OA (0.04 mg/kg) was intravenously injected into dogs. We measured the in vivo S/V (equivalent to the inverse of optical mean free path by light-scattering stereology and the pressure-volume (PV) curve 60-90 min after OA administration. OA administration decreased the lung volume at each transpulmonary pressure and increased the wet-to-dry weight ratio. The S/V decreased after OA administration (optical mean free path increased). The air-filled PV curves shifted downward after OA, but the saline-filled PV curves after OA administration did not differ significantly from control saline-filled curves. The difference in transpulmonary pressure between air- and saline-filled PV curves (an index of the magnitude of surface tension) was increased in OA-induced pulmonary edema. This study suggests that in OA-induced pulmonary edema the alveolar surface tension increases and the S/V decreases, presumably due to inactivation of surfactant by serum leakage to alveoli.
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Affiliation(s)
- S Suzuki
- First Department of Internal Medicine, Yokohama City University School of Medicine, Japan
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18
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Abstract
To investigate how pulmonary surfactant influences alveolar structure in vivo, we examined the alveolar surface area-to-lung volume (S/V) ratio of the lung parenchyma of a live dog by light-scattering stereology before and after saline lavage. We measured the backscattered light pattern produced by applying a laser beam to the pleural surface of a ventilated animal and obtained the S/V [equivalent to the inverse of the optical mean free path (lambda)]. After saline lavage, V at transpulmonary pressure (P) of 30 cmH2O (defined as total lung capacity) decreased by 11.1 +/- 3.1% (SD) and the P-V curve shifted to a lower V. The lambda-V curve was shifted to a higher lambda and to a lower V after saline lavage. S/V decreased after saline lavage (lambda increased by 38 +/- 27% on the deflation limb at a V of 80% of control total lung capacity). The alveolar surface tension increased after saline lavage, and the increase in surface tension was greater on inflation than on deflation. We conclude that depletion of pulmonary surfactant increases the alveolar surface tension in vivo, resulting in a decrease in S/V.
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Affiliation(s)
- N Miyazawa
- First Department of Internal Medicine, Yokohama City University School of Medicine, Japan
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Ninomiya S, Narahara K, Yokoyama Y, Tsuji K, Ito S, Akahori W, Akahori T, Seino Y. Interchange trisomy 9 due to maternal t(6;9) translocation. Acta Paediatr Jpn 1994; 36:519-21. [PMID: 7825455 DOI: 10.1111/j.1442-200x.1994.tb03238.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The occurrence of interchange trisomy due to a 3:1 malsegregation has been documented in only a few cases with trisomy 21. We describe the first case of interchange trisomy 9 due to a maternal t(6:9) translocation. The patient, a boy neonate who died immediately after birth, had intra-uterine growth retardation, specific craniofacial features including microcephaly with a high forehead, low-set ears, upslanting short palpebral fissures, microphthalmia, bulbous nose and micrognathia, cryptorchidism, cystic kidney and various skeletal anomalies. His phenotype was consistent with that of the trisomy 9 syndrome. Cytogenetic analysis showed his karyotype of 47,XY,-6, + der(6), + der(9)t(6;9)(q27;q21.1)mat. The present report indicates that a very rare interchange mode of a 3:1 segregation can give rise to a live birth with full trisomy 9 in female carriers with reciprocal translocations involving the proximal long arm of chromosome 9.
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Affiliation(s)
- S Ninomiya
- Department of Pediatrics, Okayama University Medical School, Japan
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20
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Akahori T, Suzuki S, Suzuki M, Okubo T. Dynamic behavior of alveolar surface-to-volume ratio in live dogs by light-scattering stereology. J Appl Physiol (1985) 1993; 75:1624-9. [PMID: 8282612 DOI: 10.1152/jappl.1993.75.4.1624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
To investigate the behavior of the surface-to-volume ratio (S/V) in lung lobes of live dogs, we measured the backscattered light pattern produced by applying a laser beam to the pleural surface. This pattern was used to estimate the optical mean free path, which is approximately proportional to the inverse square of the geometric S/V. Measurements were performed in mechanically ventilated animals with the chest widely opened. We found that during quasi-static large volume excursion, S/V changed approximately as the one-third power of lung volume but with hysteresis such that S/V during deflation was higher than during inflation. This finding is consistent with a relatively large stress hysteresis of surface tension compared with that of the tissue. During tidal breathing, however, the geometric hysteresis was inconsistent among animals at low frequency but was consistently changed at higher frequencies in a direction suggesting a lesser role of surface tension relative to tissue stress hysteresis.
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Affiliation(s)
- T Akahori
- First Department of Internal Medicine, Yokohama City University School of Medicine, Japan
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Abstract
We studied whether inspiratory muscle training (IMT) changed respiratory sensation during exercise in 12 healthy women; IMT was performed twice daily, for 15 minutes, using a pressure threshold device and continued for 4 weeks. The inspiratory threshold was set to 30 percent of each individual's maximal inspiratory pressure (Pimax). Breathing effort was evaluated during a progressive exercise test using Borg scale. After IMT, both Pimax and maximal transdiaphragmatic pressure increased by 30 percent in the training group (p < 0.05) but did not change in the control group. Prior to IMT, the Borg score increased in proportion to exercise grade. The difference in the sensory score-exercise stage curves before and after IMT in the training group was not significant. No significant difference was noted in the relationship of the Borg score to minute ventilation before and after 4 weeks in either group. We concluded that IMT may not affect respiratory sensation during exercise in normal subjects, although IMT increases diaphragmatic strength.
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Affiliation(s)
- S Suzuki
- 1st Department of Internal Medicine, Yokohama City University School of Medicine, Kanagawa, Japan
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Nakashima M, Yamamoto J, Shibata M, Uematsu T, Shinjo H, Akahori T, Shioya H, Sugiyama K, Kawahara Y. Pharmacokinetics of temocapril hydrochloride, a novel angiotensin converting enzyme inhibitor, in renal insufficiency. Eur J Clin Pharmacol 1992; 43:657-9. [PMID: 1493850 DOI: 10.1007/bf02284968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
The pharmacokinetics of temocapril hydrochloride, a novel prodrug-type angiotensin-I converting enzyme (ACE) inhibitor, has been studied in patients with mild (Group II) to severe (Group III) renal insufficiency in comparison with subjects with normal renal function (Group I). The pharmacokinetic parameters of the active diacid metabolite, including Cmax, AUC and half-life (t1/2), showed only slight changes between the three groups: AUC (0-inaffinity) was significantly larger in Group III than Group I, and t1/2 tended to be prolonged in Group III, but the change was not significant. The urinary recovery of the diacid was significantly decreased in Group III. (Group I, 28.1%, Group II, 21.6%, Group III, 12.8%). Compared with other ACE inhibitors, which are mainly excreted through the kidney, the plasma concentration of the active diacid metabolite was hardly influenced by renal function. It was speculated that lowering of the dose of temocapril might be recommended only in patients with severe renal insufficiency.
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Affiliation(s)
- M Nakashima
- Department of Pharmacology, Hamamatsu University School of Medicine, Japan
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Miyashita A, Suzuki S, Suzuki M, Numata H, Suzuki J, Akahori T, Okubo T. Effect of thyroid hormone on in vivo contractility of the canine diaphragm. Am Rev Respir Dis 1992; 145:1452-62. [PMID: 1596018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study was designed to examine the effects of long-term (4 wk) administration of thyroid hormone on the in vivo contractility of the canine diaphragm. We implanted a pair of piezoelectric crystals chronically in the left crural and costal parts of the diaphragm by a midline laparotomy. Contractility was assessed by changes in the shortening of muscle fibers after twitch stimulation of both the crural and the costal parts of the diaphragm and in the transdiaphragmatic pressure (Pdi) after tetanic stimulation (10 to 100 Hz). As a reference, we also studied the response of the quadriceps femoris. Pretreatment measurements were taken 2 wk after surgery. Then, dogs assigned to the hyperthyroid group were given thyroid powder, 0.6 g/kg/day, orally for 4 wk. The control group was fed a diet without thyroid powder for 4 wk. Serum free-T4 level (RIA) in the hyperthyroid group (n = 9) increased from 0.68 +/- 0.07 to 5.72 +/- 0.95 ng/dl (mean +/- SE) (p less than 0.01). Pdi decreased 30 to 40% at all frequencies (p less than 0.05) except 10 Hz. Twitch shortening of the crural and costal parts, compared with pretreatment state, decreased significantly by 47.7 +/- 13.1 and 48.1 +/- 15.0%, respectively (p less than 0.05). The maximal rate of relaxation became significantly faster, by 63.5% (p less than 0.05), in the crural part, whereas that of the costal part tended to become faster but not to a significant extent. In the quadriceps femoris, although twitch force showed no change, both the maximal rate of contraction and maximal rate of relaxation became faster, and tetanic force decreased. Histologic examination of hyperthyroid dogs showed vacuolization and loss of fiber area of the diaphragm. These observations suggest that thyroid hormone impairs contractility of both the crural and costal parts of the diaphragm similarly, and that the decrease in contractility may be due to a loss of muscle mass and summation impairment of twitch contraction, which differs from that in other skeletal muscles.
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Affiliation(s)
- A Miyashita
- First Department of Internal Medicine, Yokohama City University School of Medicine, Japan
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Suzuki S, Suzuki J, Ishii T, Akahori T, Okubo T. Relationship of respiratory effort sensation to expiratory muscle fatigue during expiratory threshold loading. Am Rev Respir Dis 1992; 145:461-6. [PMID: 1736758 DOI: 10.1164/ajrccm/145.2_pt_1.461] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We investigated whether fatigue of the expiratory muscle, that is, the abdominal muscle, may account for a change in the respiratory effort sensation in normal subjects during expiratory threshold loading. The respiratory effort sensation was scored using a modified Borg scale. Expiratory muscle fatigue was assessed both from changes in the maximal static expiratory pressure and in the centroid frequency (fc) of the abdominal muscle electromyogram (EMG). Expiratory threshold loading (magnitude of threshold; 40 to 60% of the maximal expiratory pressure at FRC, breathing frequency = 15/min, and duty cycle = 0.5) was continued until exhaustion or for 30 min. Loading was repeated following a 15-min recovery period after the end of the first expiratory loading. The maximal static expiratory pressure during loading (Pmmax) decreased initially and then remained decreased. Decreases were smaller with the 40% load (22 +/- 6%, SEM) than with the 60% load (37 +/- 3%) (p less than 0.05). The decrease during the second run of the 60% load was greater than during the first (p less than 0.01 by ANOVA). The maximal expiratory pressure at TLC before the second run of the 60% load was decreased by 9 +/- 3% compared with the control (p less than 0.02) but that with the 40% load was not. The fc with the 60% load decreased initially by 8 +/- 1% and then remained constant, although no change was observed with the 40% load.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Suzuki
- First Department of Internal Medicine, Yokohama City University School of Medicine, Japan
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Takeuchi S, Akahori T, Mochizuki M, Kono M. [Usefulness of magnetic resonance imaging (MRI) in the detection of the lesions of gestational trophoblastic disease--comparison with computed tomography and digital subtraction angiography]. Nihon Sanka Fujinka Gakkai Zasshi 1992; 44:159-66. [PMID: 1312111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Twenty patients with gestational trophoblastic disease (GTN) were examined by Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Digital Subtraction Angiography (DSA), to evaluate their usefulness in the diagnosis of the disease. The lesions of hydatidiform mole were mainly composed of molar vesicles, dilated vessels and hemorrhage which were depicted as small round high intensity lesions on the T2-weighted images and as tree-like low intensity lesions and high or low intensity lesions of various shapes in the T1-, T2-weighted images. These MRI findings closely corresponded to the histopathological findings. On the other hand, CT findings obtained with hydatidiform mole were characterized by filling defects or a small round low density area on contrast enhanced images. The detection ratio for intramural lesions of invasive mole and choriocarcinoma by MRI was 83% (5/6), while that by CT was 50% (3/6). The obliteration of the junctional zone and interruption of the myometrium observed in MRI were significant signs suggesting intramural invasion of the disease. In fact, these signs in MRI were observed in all of the six cases with invasive mole or choriocarcinoma examined. In conclusion, MRI is a powerful means for the determining the intramural invasive mole and choriocarcinoma. Thus more accurate diagnosis of GTN will be obtained with the combined use of MRI and DSA.
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Affiliation(s)
- S Takeuchi
- Department of Obstetrics and Gynecology, Kobe University School of Medicine
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Suzuki S, Akahori T. [Inhalation therapy--effect of spacer]. Kokyu To Junkan 1991; 39:547-53. [PMID: 1678546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Suzuki
- First Department of Internal Medicine, Yokohoma City University School of Medicine
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Yamasaki M, Akahori T, Mochizuki M, Kono M. [Usefulness of magnetic resonance imaging (MRI) in pre-treatment evaluation of the extension of uterine cervical carcinoma]. Nihon Sanka Fujinka Gakkai Zasshi 1990; 42:167-73. [PMID: 2313145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fifty-four patients with primary carcinoma of the cervix were examined by magnetic resonance imaging (MRI). Different pulse sequences with T1 and T2 weighting were employed to determine optimum tissue contrast. The tumor had a uniform signal intensity similar to the myometrium on the T1 weighted image. In contrast, the tumor signal intensity increased on the T2 weighted image. In our series the primary tumor was clearly defined in nine of twenty patients with stage 0 and I disease and thirty-three of thirty-four patients with stage II, III and IV disease. In addition, the primary tumor was clearly defined in four patients who had unsatisfactory colposcopic findings (UCF). Parametrial invasion of the tumor was well depicted on transverse planes in four of twelve sides with stage IIb disease and twenty-eight of thirty-four sides with stage III and IV disease. T1 weighted images provided excellent tissue contrast between the high signal from pelvic fat and the low intensity of tumor tissue enabling demonstration of involvement of the pelvic side wall. Vaginal invasion was also clearly seen on T2 weighted sagittal images in seventeen of twenty-six patients. In conclusion, MRI is not only useful but is also a non-invasive method of detecting primary tumor and extra-uterine extension of cervical carcinoma.
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Affiliation(s)
- M Yamasaki
- Department of Obstetrics and Gynecology, Kobe University School of Medicine
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Kinugasa M, Akahori T, Mochizuki M, Hasegawa K. [Immunologic significance for regional lymph node histology in uterine cervical cancer]. Nihon Gan Chiryo Gakkai Shi 1989; 24:7-15. [PMID: 2738442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To evaluate the immunological significance for regional lymph node histology in uterine cervical cancer, 1,144 lymph nodes of 153 cases were studied. Four histological findings in lymph nodes as follows were evaluated: Paracortical Area (PA), Sinus Histiocytosis (SH), Germinal Center (GC) and Degenerative Changes (DC). PA was well developed in early cancer, while hypoplastic in advanced cancer. SH appeared in early stages and disappeared gradually as cancer progressed. GC was most hyperplastic in stage I b and hypoplastic in stage I a and III. DC was remarkable in advanced cancer. The findings of PA of the regional lymph nodes in the cases without metastasis, and those of PA, GC and DC of the metastatic lymph nodes in the cases with metastasis were well correlated with prognosis. These results indicate that investigation of the histology of lymph nodes draining uterine cervical cancer may give valuable information to evaluate the immune response of the patients and to predict their prognosis.
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Yamasaki M, Maruo T, Akahori T, Mochizuki M. [Immunohistochemical studies on epidermal growth factor receptor and the myc oncogene product in squamous cell carcinoma of the uterine cervix]. Nihon Sanka Fujinka Gakkai Zasshi 1988; 40:51-8. [PMID: 3280708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Recent studies have demonstrated that the amount of epidermal growth factor receptor (EGF-R) is increased in squamous cell carcinoma cells and that the amino acid sequence of EGF-R shows great homology with the v-erb B transforming protein. In this study, we examined the tissue localization of EGF-R and myc oncogene product in normal squamous epithelium, dysplasia, carcinoma in situ, invasive squamous cell carcinoma of the uterine cervix and in metastatic lymph nodes by means of the avidin/biotin immunoperoxidase technique. Normal squamous epithelium was negative for EGF-R and myc product. The lesions of dysplasia and carcinoma in situ had a positive staining for EGF-R, but were still negative for myc product. There were differences in the staining intensity of EGF-R and myc product among the types of invasive carcinoma. Staining for EGF-R and myc product was negative in small cell non-keratinizing carcinoma, whereas strong staining for both EGF-R and myc product was observed in large cell non-keratinizing and keratinizing carcinoma. The intensity of positive staining for EGF-R and myc product declined in the lesions of cancer pearl. Metastatic lymph nodes were remarkably stained for EGF-R and myc product, while non-metastatic lymph nodes were negative for EGF-R and myc product. Our observations suggest that the amplified expression of EGF-R and myc product may accompany the malignant transformation of squamous epithelium of the uterine cervix, together with the metastasis.
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Affiliation(s)
- M Yamasaki
- Department of Obstetrics and Gynecology, Kobe University School of Medicine
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Hasegawa K, Akahori T, Ohtsu F, Kinugasa M, Takeuchi K, Tokiwa Y, Takeuchi Y, Mocihzuki M. [Study on histological grading of malignancy of cervical adenocarcinoma]. Nihon Gan Chiryo Gakkai Shi 1987; 22:790-800. [PMID: 3668354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Akahori T, Hasegawa K, Ohtsu F, Kinugasa M, Takeuchi K, Tokiwa Y, Takeuchi Y, Mochizuki M. [Cytologic studies of cervical adenocarcinoma]. Nihon Sanka Fujinka Gakkai Zasshi 1987; 39:70-8. [PMID: 3819515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Seventy three cases of cervical adenocarcinoma, classified histologically according to WHO classification, were cytodiagnostic examined for cellular arrangement, cellular shape, nuclear shape, chromatin pattern and appearance rate of nucleolus. In adenosquamous carcinoma, the observed cancer cells were classified further into five categories and the incidence of each type was clarified. The authors obtained the following conclusions. The cytological findings in cellular arrangement, cellular shape, chromatin pattern and nucleolus findings were closely related with the degree of differentiation of endocervical type adenocarcinoma. Since no substantial cytodiagnostic differences were seen between endometrioid adenocarcinoma and endocervical type adenocarcinoma, it appears to be difficult to differentiate between them. Clear cell adenocarcinoma is characterized by sheet-like cell arrangement, polycrystal cell shape, round nuclei, finely granular chromatin pattern and appearance of macronucleolus. Among them the occurrence of macronucleolus was clearly observed and appeared of high value in making a diagnosis. Adenosquamous carcinoma, showing no characteristic finding in cytology, is proved to have morphological diversity. Careful observation of the intermediate type cancer cells is necessary to presume the histology of adenosquamous carcinoma.
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Tashiro H, Teraoka T, Akahori T, Naito H, Matsui H. [Conference: learning through clinical training. Nursing action to remove the factors obstructing the desire for recovery]. Kurinikaru Sutadi 1984; 5:1222-31. [PMID: 6569927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Abstract
The uptake of 125I-labelled LH by equal numbers of granulosa cells from small, medium or large follicles was greater by cells from large follicles. In contrast, granulosa cells obtained from small follicles bound much more 125I-labelled FSH per cell than did cells obtained from medium and large follicles. Competition studies with unlabelled hormones indicated that porcine granulosa cells have specific receptors for LH and FSH. The addition of diethylstilboestrol enhanced the binding of 125I-labelled LH and inhibited the binding of 125I-labelled FSH to granulosa cells harvested from small and medium-sized follicles, but had no effect on those from large follicles.
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Nakano R, Akahori T, Kotsuji F, Tojo S. Follicle-stimulating hormone response to luteinizing-hormone-releasing hormone in patients with hydatidiform mole. Obstet Gynecol 1975; 46:453-5. [PMID: 1101122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The serum concentration of immunoreactive follicle-stimulating hormone (FSH) and FSH response to synthetic luteinizing-hormone-releasing hormone (LHRH) were investigated in 9 patients with intact hydatidiform moles and 3 patients with aborted moles. The serum concentration of FSH before and after intravenous administration of 200 mug of synthetic LHRH was measured by double antibody radioimmunoassay. Serum FSH was detectable but relatively low compared with the levels seen in the follicular phase of the normal menstrual cycle in all 12 patients. Furthermore, the 12 patients did not respond, or responded subnormally, to exogenously administered LHRH, and there was no significant elevation in serum FSH levels after LHRH injection. The result of the current study is in accord with that of our previous report on the serum concentration of FSH and FSH response to synthetic LHRH during normal pregnancy. Thus, it might be concluded that the follicle-stimulating activity of the anterior pituitary is suppressed by an unknown mechanism during molar pregnancy as well as normal pregnancy.
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