Beneficial effect of interferon-β treatment in patients with multiple sclerosis is associated with transient increase in serum IL-6 level in response to interferon-β injection

In order to predict the clinical benefit of interferon-beta (IFN-beta) to patients with multiple sclerosis (MS), the following markers were investigated; (1) chronological change of cytokines (IFN-gamma, TNF-alpha, IL-6, IL-10, and TGF-beta) after administration of IFN-beta, (2) untoward effects of IFN-beta such as headache and arthralgia, (3) backgrounds of the patients such as age and relapse rate, (4) efficacy of IFN-beta therapy assessed by the change of relapse rate and progression of disability. Chronological blood sampling was performed 0, 10, and 24 h after injection of IFN-beta. The increase of serum IL-6 level in response to IFN-beta administration was associated with headache, arthralgia, relapse rate before treatment, and disability score at the initiation of the therapy. Significant association of change of serum TNF-alpha with age and headache was also observed. The important finding in this study was that patients with a transient increase in IL-6 in response to IFN-beta showed a slow disease progression. This result suggests that this transient increase in the serum IL-6 predicts favorable response to IFN-beta treatment.

Altered sarcoplasmic reticulum function in rat diaphragm after high-intensity exercise

The present study examined the effects of acute high-intensity exercise on Ca(2+) uptake and release rates and Ca(2+)-adenosine triphosphatase (ATPase) activity of the sarcoplasmic reticulum (SR) from the costal diaphragm. The rats were run on a treadmill at an estimated requirement of 100% of maximal O2 consumption until fatigued (average time to exhaustion: 4.79 min). Muscle lactate and inorganic phosphate after exercise were increased by 65% (P < 0.05) and 35% (P < 0.05), respectively. With exercise, Ca(2+) uptake and release, which were detected in homogenates using the Ca(2+) fluorescent dye indo-1, were decreased by 24% (P < 0.05) and 22% (P < 0.05), respectively. The reduction in Ca(2+) uptake was paralleled by decreased activity of SR Ca(2+)-ATPase in both the absence and presence of Ca(2+) ionophore. These findings demonstrate that, in the diaphragm as well as in the locomotor muscles that have been explored in previous studies, the attenuations of the SR function is brought about by acute high-intensity exercise. These changes in the SR of the diaphragm may contribute, at least in part, to deteriorations in exercise tolerance and work productivity resulting from repetitive physical activities.

[A case of spinal muscular atrophy with marked calf hypertrophy and adolescent onset]

We report on a 41-year-old male patient with spinal muscular atrophy (SMA). He had slowly progressive muscular weakness and hypertrophic calves since 14 years of age. The upper arms were slightly, and the thighs moderately atrophic, but the calves were remarkably hypertrophic. There was muscle weakness of both the upper and lower limbs, being more proximal in distribution. He had a positive Gowers' sign and his gait was slightly waddling. Serum creatine kinase level was elevated (518IU/l). Electromyogram revealed a neurogenic pattern. Muscle biopsy of the left biceps brachii showed chronic neurogenic changes. Immunohistochemical examination and Western blot analysis using anti-dystrophin antibodies showed no abnormality. DNA analysis with multiplex PCR proved no deletion in the dystrophin gene, while deletions of exons 7 and 8 of the telomeric copy of survival motor neuron gene were detected. In 1978, Pearn et al. described a new variant syndrome of SMA, characterized by adolescent onset, gross hypertrophy of calves, and a slowly progressive clinical course. The present case is compatible with this syndrome. Therefore, it is suggested that this syndrome, mimicking Becker muscular dystrophy, is not an independent clinical entity, although the phenotype of this syndrome is different from that of typical SMA.

Undetectable dystrophin can still result in a relatively benign phenotype of dystrophinopathy

We present here a 28-year-old male patient with Becker muscular dystrophy whose skeletal muscle showed an absence of dystrophin. He has had progressive and predominantly proximal muscular wasting since 5 years of age, but was able to walk until 26 years of age. He showed hypertrophic calves, cardiomyopathy, and an elevated serum creatine kinase level (934 U/1). A skeletal muscle biopsy revealed advanced chronic myopathic changes. Immunohistochemical examination using anti-dystrophin antibodies against C-terminus showed deficiency of the protein. Rod domain and N-terminus were also absent in almost all muscle fibers, but only in a small part of the sample, they were faintly stained. beta-Dystroglycan and utrophin were present only in a small number of muscle fibers. DNA and RT-PCR analysis showed a frame-shift deletion of exons 3-7 in the dystrophin gene. In such an exceptional case as this one, it is important to investigate the factors which determine the severity of dystrophinopathy.

[A family with facioscapulohumeral muscular dystrophy and hereditary long QT syndrome]

We describe a family with facioscapulohumeral muscular dystrophy (FSHD) and hereditary long QT syndrome (LQT) for three generations. The proband, a 50-year-old woman, had noticed difficulty in raising the upper extremities since the age of 40. At the age of 48, she was admitted to our hospital because of arrhythmia attack. She, her mother, and one of her three children were diagnosed as having LQT. These three individuals and the proband's two siblings were clinically diagnosed as having FSHD which was confirmed by genetic analysis using EcoR1. FSHD is an autosomal dominant disorder and the gene locus is mapped to chromosome 4q35-ter, but the gene has not been isolated. LQT is a group of disorders which cause syncope and sudden death from ventricular arrhythmia in an autosomal dominant fashion. Four loci for this syndrome (LQT1-4) have been known, and three of the genes have been shown to encode ion-channels. Genetic analysis of the proband failed to detect any of previously known mutations in the LQT1, LQT2, and LQT3 genes. The locus for LQT4 has been mapped to chromosome 4q25-7. There have so far been no report of FSHD associated with LQT. Although the pathogenesis is unclear, we speculate that these two diseases are linked each other on chromosome 4q.

Involvement of the central nervous system in myotonic dystrophy

To investigate the etiological factors responsible for intellectual impairment and mood changes in patients with myotonic dystrophy (DM), we evaluated 14 patients with DM by means of neuropsychological evaluation and magnetic resonance images (MRI). There were significant differences between patients and controls in regard to the Barthel index, Zung's depression scale, attention, verbal fluency and digit span. All patients had ventricular enlargement and white matter abnormalities on MRI. However, the severity was variable and there was no difference in neuropsychological testing between patients with mild ventricular dilatation and those with severe dilatation. On the other hand, significant differences were present between patients with mild white matter lesions and those with severe white matter abnormalities in regard to verbal fluency and attention. Neuropathologic examination of an autopsied brain showed an increase in the interfascicular space of the white matter which produced pallor on myelin staining. The present findings suggested that the white matter abnormalities were the cause of cognitive impairment among patients with DM.

[Protein metabolism in vegans]

To elucidate the mechanisms of adaptation to a low-energy and low-protein vegan diet, we carried out dietary surveys and nitrogen balance studies five times during one year on two women and a man who ate raw brown rice, raw green vegetables, three kinds of raw roots, fruit and salt daily. Individual subjects modified this vegan diet slightly. The mean daily energy intake of the subjects was 18, 14, and 32 kcal/kg, of body weight. The loss of body weight was about 10% of the initial level. The daily nitrogen balance was -32, -33, and -11 mg N/kg of body weight. In spite of the negative nitrogen balance, the results of routine clinical tests, initially normal, did not change with the vegan diet. Ten months after the start of the vegan diet, the subjects were given 15N urea orally. The incorporation of 15N into serum proteins suggested that these subjects could utilize urea nitrogen for body protein synthesis. The level of 15N in serum proteins was close to the level in other normal adult men on a low-protein diet with adequate energy for 2 weeks.

Effects of aerobic conditioning at intensities corresponding to lactate threshold plus reduced energy intake in college-age females

The effects of a 15-wk aerobic conditioning (4.2 +/- 1.3 d/wk) plus energy restriction (25 kcal/kg/d diet) program on anthropometric and physiologic attributes were studied in 16 obese women between the ages of 18 and 24. The women were divided into either an experimental (E, n = 10) group or a control (C, n = 6) group. The exercise + diet (E) group demonstrated significant reductions in body weight, both absolute and relative body fat, Katsura index, and serum triglycerides, and increases in oxygen uptake relative to lactate threshold (LT), maximal oxygen uptake, and the ratio of high-density lipoprotein cholesterol to total cholesterol. In the C group, none of the variables measured in this study remained unchanged. Thus the benefits of weight reduction without any change in fat free weight following the program were pronounced in the female university-age group that we studied. In conclusion, the highly structured aerobic conditioning at intensities corresponding to LT together with a proper dietary regimen is considered optimal with respect to favorable changes in various anthropometric and physiologic attributes. The feasibility of treating obese individuals with manifestation of medical and/or psychological problems in a school setting should be a significant matter in future research.

Single-photon emission computed tomographic investigation of patients with motor neuron disease

To investigate the correlation between involvement of the CNS in motor neuron disease (MND) and neuroimaging abnormalities, we studied 18 patients with MND by single-photon emission computed tomography (SPECT) and MRI. Patients were divided into four groups according to the results of SPECT. Group 1 consisted of four patients with reduced isotope uptake in the frontal lobe, including the motor area, and in the anterior part of the temporal lobe; group 2 consisted of two patients with reduced isotope uptake in the motor area spreading to the adjacent frontal lobe; group 3 consisted of eight patients with reduced isotope uptake confined to the motor area; and group 4 consisted of four patients without reduced isotope uptake. We found dementia in group 1, borderline dementia in group 2, and no cognitive deficit in group 3 or four. MRI demonstrated enhanced T2-weighted signals along the pyramidal tract in eight patients, but this finding also existed in some control subjects. SPECT appears useful in identifying the location of cortical neuronal degeneration in patients with MND.

Significance of subclinical entrapment of nerves in lead neuropathy

We examined a left-handed 25-year-old man engaged for 2 years at a vinyl chloride resin factory where he had been exposed to lead stearate, a stabilizer of resin. Neurological examination revealed atrophy of small hand muscles, especially in the left dorsal interossei. Sensation of all modalities was intact. A nerve conduction study showed conduction block at the elbow, indicating possible cubital tunnel syndrome. Following CaEDTA therapy, continued recovery of conduction velocities, amplitude of compound muscle action potential, and diminution of conduction block at elbow were observed within a few months. In lead intoxication, nerves may incur mechanical damage. Subclinical entrapment may thus be an important factor leading to vulnerability of nerves in lead neuropathy.

[A case of lead neuropathy--importance of subclinical entrapment of nerves in lead neuropathy]

The patient was a left handed 25-year-old man who had worked in a vinyl chloride resin factory since July 1987 using lead stearate as a stabilizer. During the two years preceding hospitalization, he had been admitted three times for colicky abdominal pain with constipation and nausea. Anemia and proteinuria without causative diseases were pointed out. Because of progressive muscle weakness of hands which began since January 1989, he was admitted to our neurologic clinic on October 2 1989. Neurological examination showed severe atrophy of both small hand muscles without sensory disturbances. Left hand was predominantly affected, especially in interossei muscles. Laboratory findings are as follows; RBC 3.25 million/cu.mm: Hb 9.7 g/dl:blood lead concentration 100 micrograms/dl: urinary coproporphyrin 4503 micrograms/l: urinary delta-ALA 138 mg/l: and urinary lead excretion after 1 g CaEDTA infusion: 3938 micrograms/day. Electromyography of extensor carpi radialis, flexor carpi ulnaris and opponens showed increased polyphasic, long duration MUPs. Electromyography of dorsal interossei showed fibrillation. Nerve conduction study showed mildly decreased motor and sensory conduction velocities and markedly reduced amplitude of compound muscle action potentials (CAMPs). Investigation by inching method revealed conduction block of left ulnar nerve across elbow. After CaEDTA chelating therapy, 1 g once a week, steady improvement of muscular weakness was observed within a few months. Serial nerve condition studies revealed constant recovery of nerve conduction velocities, amplitude of CMAPs and diminution of conduction block across the left elbow. Conduction block across left elbow without sensory disturbances implies that subclinical cubital tunnel syndrome might have existed in this patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Assessment of body composition by bioelectrical impedance analysis: effects of skin resistance on impedance]

Effects of skin resistance on impedance values were studied in order to propose reliable determination of body composition in human. Analysis of the data indicated that impedance values (Z = (R2 + Xc2)0.5) varied considerably in the following conditions: 1) 230 +/- 97.8 ohms when electrodes were directly attached; 2) 490 +/- 52.5 ohms when electrodes were attached immediately after use of alcohol; 3) 584 +/- 44.1 ohms when electrodes were attached immediately after use of alcohol with electrode gel; and 4) 589 +/- 45.0 ohms when electrodes were attached in the order of elimination of skin resistance----use of alcohol----use of electrode gel. We suggest that impedance obtained by the bioelectrical impedance analysis should be measured immediately after elimination of skin resistance at least with electrode gel.

Electrophoretic immunoblotting analysis of anti-thymus microsome antibodies in patients with myasthenia gravis

Anti-thymus microsome antibodies and anti-skeletal muscle microsome antibodies in sera from patients with myasthenia gravis (MG) were analyzed by means of immunoblotting, which was performed after SDS polyacrylamide gel electrophoresis of antigens to clarify the pathogenic role of the thymus in MG. Anti-thymus microsome antibodies were detected in 15 of the 20 cases of MG examined. The detection frequency (75%) was significantly higher than the corresponding frequency determined for anti-muscle microsome antibodies (35%) in the same group of patients. Thymic antigens with a molecular weight of 38 kilodaltons (KD), 60 KD and 220 KD were often recognized by antibodies in sera from MG patients studied here. The anti-thymus microsome antibodies were not cross-reactive with either thymic acetylcholine receptors or lymphocyte surfaces. These findings indicated that the specific antibodies were produced to the thymic microsomal fraction, and its frequency was higher than has been suspected in MG patients.

Parkinson's disease and myasthenia gravis: adverse effect of trihexyphenidyl on neuromuscular transmission

A 55-year-old man with idiopathic Parkinson's disease developed myasthenia gravis shortly after taking trihexyphenidyl. The myasthenic weakness waxed and waned with rise and fall in serum levels of trihexyphenidyl, without marked change of anti-acetylcholine receptor antibody titer.

[Pharmacokinetics and toxicity of intrathecal administration of recombinant interleukin 2]

In order to contribute to the development of adoptive immunotherapy against malignant brain tumors, the pharmacokinetics and toxicity of intrathecally administered recombinant interleukin-2 in dogs and human patients were analyzed. The pharmacokinetics showed that a high concentration of IL-2 was maintained in the intrathecal cavity in both dogs and human (t1/2 = 1.41 and 1.68 hours, respectively) after administration. However, no activity of IL-2 was detected in the cerebrospinal fluid after the systemic administration of rIL-2 in one dog. No meningitis, ventriculitis or degeneration of neurons was seen histopathologically in dogs 3 weeks after the intrathecal administration of rIL-2 (200 units). A high concentration of IL-2 in the tumor cavity was maintained for a very long time (t1/2 = 14.8 hours) after the intratumoral administration of rIL-2 in one of the patients. Although low-grade fever and mild headache were sometimes observed after the intrathecal administration of rIL-2 in patients, there was no other side effect mentioned. Intrathecal or intratumoral administration of rIL-2 appeared to be an valuable procedure which should be evaluated in conjunction with adoptive immunotherapy against malignant brain tumors.

A prediction equation for indirect assessment of anaerobic threshold in male distance runners

The predictability of anaerobic threshold (AT) from maximal aerobic power, distance running performance, chronological age, and total running distance achieved on the treadmill (TRD) was investigated in a sample of 53 male distance runners, 17-23 years of age. The dependent variable was oxygen uptake (Vo2) at which AT was detected (i.e. Vo2 @ AT). A regression analysis of the data indicated Vo2 @ AT could be predicted from the following four measurements with a multiple R = 0.831 and a standard error of the estimate of 2.66 ml . min-1 . kg-1: Vo2max (67.9 +/- 5.7 ml . min-1 . kg-1), 1,500-m running performance (254.5 +/- 14.2 s), TRD (6.82 +/- 1.13 km), and age (19.4 +/- 2.2 years). When independent variables were limited to Vo2max (X1) and 1,500-m running performance (X2) for simpler assessment, a multiple R = 0.806 and a standard error of the estimate of 2.76 ml . min-1 . kg-1 were computed. A useful prediction equation with this predictive accuracy was considered to be Vo2 @ AT = 0.386X1 - 0.128X2 + 57.11. To determine if the prediction equation developed for the 53 male distance runners could be generalized to other samples, cross-validation of the equation was tested, using 21 different distance runners, 17-22 years of age. A high correlation (R = 0.927) was obtained between Vo2 AT predicted from the above equation and directly measured Vo2 @ AT. It is concluded that the generalized equation may be applicable to young distance runners for indirect assessment of Vo2 @ AT.

Improvement of abnormal pyruvate metabolism and cardiac conduction defect with coenzyme Q10 in Kearns-Sayre syndrome

In a patient with Kearns-Sayre syndrome, concentration of coenzyme Q10, a component of the mitochondrial electron transport system, was decreased in serum and in the mitochondrial fraction of skeletal muscle. Serum concentrations of lactate and pyruvate were abnormally high, especially after exercise or oral glucose loading. Levels of folic acid in plasma and CSF were decreased. ECG showed a first-degree atrioventricular block. After administration of coenzyme Q10 60 to 120 mg daily for 3 months, serum levels of lactate and pyruvate became normal, with improvement of atrioventricular block and ocular movements.

Focal luxury perfusion with an early-filling vein in relation to neurological symptoms evoked by heat

A 50-year-old man with a 1-year history of transient attacks of left total hemiparesis was admitted to hospital with a complaint of increasing frequency of attacks. Minimal or moderate left hemiparesis was elicited by elevation of environmental temperature when taking a hot bath or a hot shower. Right carotid angiography revealed an early-filling vein near the right central sulcus. An increase of focal luxury perfusion by elevation of body temperature seemed to cause relative ischaemia in this paracentral gyrus.

Trophic effect of iron-bound transferrin on acetylcholine receptors in rat skeletal muscle in vivo

Trophic effect of iron-bound transferrin (FeTf) on the total content of acetylcholine receptors (AChRs) and the specific activity of AChRs in innervated and denervated skeletal muscle was investigated in vivo. The right ischiadic nerves of 15 rats weighing 160 g were transected. FeTf (1.2 mg/ml) was injected daily into bilateral crural muscles of rats for the following 11 days. Control groups received injections of saline or no treatment. FeTf significantly increased the total content of AChRs and the specific activity of AChRs in innervated and denervated muscle compared with control groups (P less than 0.001). This result shows that intramuscular injections of FeTf may be useful for the treatment of disorders of neuromuscular transmission.

Radioimmunoassay for antibodies to human skeletal muscle myosin in serum from patients with polymyositis

Antibodies to human skeletal muscle myosin were detected in 90% of sera from patients with polymyositis by radioimmunoassay using purified human myosin as antigen, and the mean titre was 4.24 X 10(-10)M. The incidence and the mean titre of anti-myosin antibodies were significantly higher than in patients without polymyositis. Anti-myosin antibody titres correlated with steroid therapy in polymyositis patients. Titres in untreated patients with polymyositis correlated with the severity of muscle weakness. Radioimmunoassay for anti-myosin antibodies should prove to be useful in the diagnosis of polymyositis and the evaluation of clinical state.

Serum mitochondrial aspartate aminotransferase in patients with polymyositis

The clinical significance of serum aspartate aminotransferase (GOT) isozymes was studied in 18 patients with polymyositis. Abnormally high levels of mitochondrial GOT (mGOT) (6.2 +/- 1.2 IU/L, mean +/- SEM; normal, less than 2.0 IU/L) and cytosol GOT (sGOT) (95 +/- 21.6 IU/L; normal, less than 25 IU/L) were observed in sera. In polymyositic muscles, the sGOT level was significantly decreased but mGOT was not. The levels of serum sGOT and mGOT and the ratio of mGOT/tGOT before corticosteroid therapy correlated well with the severity of muscle weakness. Serial determination of CPK, sGOT, and mGOT during corticosteroid therapy revealed that mGOT most rapidly returned to normal. Exercise did not increase serum mGOT in polymyositis.

Evaluation of the effect of CDP-choline on poststroke hemiplegia employing a double-blind controlled trial. Assessed by a new rating scale for recovery in hemiplegia

A double-blind study was conducted in order to evaluate the effect of CDP-choline on functional recovery of hemiplegia. A standardized 12-grade scale (Hemiplegia Function Test) was utilized for the evaluation. The results indicate that for the upper limbs, doses of 1,000 and 250 mg of CDP-choline were superior to placebo at 8 weeks. The higher dose showed an effect at 4 weeks equal to that at 8 weeks while the effect of the lower dose was slower but reached the same level of effect as the higher dose at 8 weeks. Similar results were obtained for the lower limbs but the effectiveness was not statistically significant. The lesser effect for the lower limbs could be attributed to the relatively small number of patients in the early stages of recovery in the present series. No significant differences were found for the effects on subjective symptoms, neurological signs and overall judgment of the physicians. The findings suggest that CDP-choline promotes natural recovery in hemiplegia.