Experimental Demonstration of the Thin-Film Liquid-Metal Jet as a Charge Stripper

For high-power heavy ion accelerators, the development of a suitable charge stripper, which can handle intense beams, is essential. This Letter describes the first experimental demonstration of a heavy ion liquid lithium charge stripper. A 10-20  μm thick liquid lithium jet flowing at >50  m/s was formed and confirmed stable when bombarded by various heavy ion beams, while increasing the charge state of the incoming beams to the desired charge state range. This demonstration proved the existing power limitation with the conventional strippers can be overcome by the liquid-metal stripper, opening completely new possibilities in high-power accelerator development.

First Simultaneous Acceleration of Multiple Charge States of Heavy Ion Beams in a Large-Scale Superconducting Linear Accelerator

Experimental studies of the simultaneous acceleration of three-charge-state ^{129}Xe^{49+,50+,51+} beam from 17 to 180  MeV/nucleon in a superconducting linear accelerator are presented. The beam parameters for each individual- and multiple-charge-state beam were measured and compared with the particle tracking simulations. Detailed measurements were performed to characterize the multiple-charge-state beam's recombination after a second-order achromat and isopath 180° bending system. As a result of the recombination of three charge states in the six-dimensional phase space, the xenon beam intensity was increased by 2.5-fold compared to the single-charge-state beam. The results presented in the Letter fully validate the possibility to produce and utilize high-quality multiple-charge-state heavy-ion beams in a large-scale superconducting linac to increase the available beam power on an isotope production target.

Simple semi-permanent blockade against rigid varus foot in a case with spasticity: possible practical benefits in ambulatory adults

A 55-year-old ambulatory woman with hemiplegia and varus foot deformity had several problems in her daily life, including load pain and stance instability in the affected foot, easy fatigue of the non-paralysed leg, low back pain, neck stiffness and rapid shoe-rubber wear on the deformed side. We began repeated focal blockades using botulinum toxin to the tibialis posterior muscle to control varus spasticity. Distant influences presenting in the whole body were relieved soon after the first blockade, and shoe wear also stopped. Although, neither the deformed appearance nor foot contact pattern on walking changed in the initial period after beginning the blockade, the foot contact pattern revealed gradual improvement over several years. Generally, surgical correction is indicated for the treatment of deformed feet. The present case suggests that, in case of varus-deformed foot with some spastic elements, trial of focal blockade for varus spasticity may be worthwhile.

Revealing Color Forces with Transverse Polarized Electron Scattering

The Spin Asymmetries of the Nucleon Experiment measured two double spin asymmetries using a polarized proton target and polarized electron beam at two beam energies, 4.7 and 5.9 GeV. A large-acceptance open-configuration detector package identified scattered electrons at 40° and covered a wide range in Bjorken x (0.3<x<0.8). Proportional to an average color Lorentz force, the twist-3 matrix element, d[over ˜]_{2}^{p}, was extracted from the measured asymmetries at Q^{2} values ranging from 2.0 to 6.0  GeV^{2}. The data display the opposite sign compared to most quark models, including the lattice QCD result, and an unexpected scale dependence. Furthermore, when combined with the neutron data in the same Q^{2} range the results suggest a flavor independent average color Lorentz force.

Decreased bone mineral density in experimental myasthenia gravis in C57BL/6 mice

Experimental autoimmune myasthenia gravis (EAMG), an animal model of myasthenia gravis (MG), can be induced in C57BL/6 (B6, H-2 ^b) mice by 2-3 injections with Torpedo californica AChR (tAChR) in complete Freund's adjuvant. Some EAMG mice exhibit weight loss with muscle weakness. The loss in body weight, which is closely associated with bone structure, is particularly evident in EAMG mice with severe muscle weakness. However, the relationship between muscle weakness and bone loss in EAMG has not been studied before. Recent investigations on bone have shed light on association of bone health and immunological states. It is possible that muscle weakness in EAMG developed by anti-tAChR immune responses might accompany bone loss. We determined whether reduced muscle strength associates with decreased bone mineral density (BMD) in EAMG mice. EAMG was induced by two injections at 4-week interval of tAChR and adjuvants in two different age groups. The first tAChR injection was either at age 8 weeks or at 15 weeks. We measured BMD at three skeletal sites, including femur, tibia, and lumbar vertebrae, using dual energy X-ray absorptiometry. Among these bone areas, femur of EAMG mice in both age groups showed a significant decrease in BMD compared to control adjuvant-injected and to non-immunized mice. Reduction in BMD in induced EAMG at a later-age appears to parallel the severity of the disease. The results indicate that anti-tAChR autoimmune response alone can reduce bone density in EAMG mice. BMD reduction was also observed in adjuvant-injected mice in comparison to normal un-injected mice, suggesting that BMD decrease can occur even when muscle activity is normal. Decreased BMD observed in both tAChR-injected and adjuvant-injected mice groups were discussed in relation to innate immunity and bone-related immunology involving activated T cells and tumour necrosis factor-related cytokines that trigger osteoclastogenesis and bone loss.

Sympathetic skin response and heart rate variability as diagnostic tools for the differential diagnosis of Lewy body dementia and Alzheimer's disease: a diagnostic test study

OBJECTIVE

The purpose of this study is to investigate the usefulness of sympathetic skin response (SSR) and heart rate variability (HRV) for the differential diagnosis of patients with dementia with Lewy bodies (DLB).

DESIGN

A diagnostic test study.

SETTING

Single centre in Japan.

PARTICIPANTS

We examined 20 patients with probable Alzheimer's disease (AD) diagnosed with NINCDS-ADRDA criteria and 20 with probable DLB diagnosed with the criteria of the third international DLB workshop.

METHODS

For the SSR measurement, surface electrodes were used: the active recording electrode was placed on the palm of the hand and the reference electrode was placed on the dorsum of the same hand. SSR was induced by a median nerve electrical stimulation at an amplitude of 20 mA. For the HRV measurement, the A-A intervals were measured twice for 2 min with an interval of 5 min in a sitting position after a rest of 5 min. From the low-frequency power (LF; 0.02-0.15 Hz) and high-frequency power (HF; 0.15-0.50 Hz), the ratio of LF to HF power (LF/HF) was calculated using the maximal entropy method.

RESULTS

SSR and HRV could detect the abnormality of autonomic function in patients with DLB at sensitivities of 85% and 90%, respectively. On the other hand, SSR and HRV detected an abnormality of autonomic function in patients with AD at sensitivities of 15% and 25% (p<0.05). The combination of the SSR and the HRV (double-positive) indicated abnormal autonomic function was recorded in only 1 of 20 patients (5%) with AD. In contrast, this combination indicated autonomic abnormality in 15 of 20 patients with DLB by our criteria (75%).

CONCLUSIONS

SSR and HRV can be applied to differentiate DLB from AD.

Autoantibody-induced internalization of nicotinic acetylcholine receptor α3 subunit exogenously expressed in human embryonic kidney cells

Autoantibody against nicotinic acetylcholine receptor (nAChR) α3 subunit has been implicated in the pathogenesis of paraneoplastic neurological syndrome. To examine the effect of anti-α3 subunit autoantibody on cell-surface nAChRs, we established human embryonic kidney 293 cells stably co-expressing α3 and β4 subunits. Upon incubation with seropositive patient's serum, this cell line showed co-accumulation of patient's IgG and α3 subunits in the cytoplasm. These data support the hypothesis that anti-α3 subunit autoantibody induces internalization of cell-surface nAChRs and thereby impairs synaptic transmission.

Observation of the (Λ)(7)He hypernucleus by the (e, e'K+) reaction

An experiment with a newly developed high-resolution kaon spectrometer and a scattered electron spectrometer with a novel configuration was performed in Hall C at Jefferson Lab. The ground state of a neutron-rich hypernucleus, (Λ)(7)He, was observed for the first time with the (e, e'K+) reaction with an energy resolution of ~0.6 MeV. This resolution is the best reported to date for hypernuclear reaction spectroscopy. The (Λ)(7)He binding energy supplies the last missing information of the A = 7, T = 1 hypernuclear isotriplet, providing a new input for the charge symmetry breaking effect of the ΛN potential.

Single turnovers of fluorescent ATP bound to bipolar myosin filament during actin filaments sliding

The nucleotide turnover rates of bipolar myosin thick filament along which actin filament slides were measured by the displacement of prebound fluorescent ATP analog 2′(3′)-O-[N-[2-[(Cy3)]amindo]ethyl] carbamoyl]-adenosine 5′ triphosphate (Cy3-EDA-ATP) upon flash photolysis of caged ATP. The fluorescence of the thick filament where actin filament slides decayed with two exponential processes. The slower rate constant was the same as that without actin filament. Along bipolar myosin thick filament, actin filaments slide at a fast speed towards the central bare zone (forward), but more slowly away from the bare zone (backward). The displacement rate constant of fluorescent ATP from the myosin filament where actin filament moved forward was 5.0 s⁻¹, whereas the rate constant where the actin filament slid backward was 1.7 s⁻¹. These findings suggest that the slow ADP release rate is responsible for the slow backward sliding movement.

A case of myasthenia gravis with cardiac fibrosis and easily provoked sustained ventricular tachycardia

A 65-year-old male, who had been diagnosed to have myasthenia gravis (MG) 25 years previously, was admitted to our hospital with faintness. Cardiac ultrasonography showed decreased left ventricular function. Magnetic resonance imaging depicted delayed contrast enhancement in localized regions. No significant coronary artery stenosis was found, and due to the reproducible susceptibility for sustained ventricular tachycardia, he underwent cardioverter-defibrillator implantation. Although relatively uncommon, cardiac manifestations should not be overlooked in MG patients, as they may be associated with ventricular arrhythmias and cardiac dysfunction.

Three-body nonmesonic weak decay of the (Lambda)12C hypernucleus

We have measured the branching ratio of the three-body process in the nonmesonic weak decay of Lambda12C to be 0.29+/-0.13. This result was obtained by reproducing the nucleon and the nucleon pair yields introducing a measured final state interaction. At the same time, we have determined the absolute decay widths, Gamma(n) and Gamma(p), along with Gamma2N, whose relative ratio has been a long-standing puzzle. Including the three-body process, we have successfully reproduced the nucleon energy distribution, the coincidence two-nucleon angular correlation, and the momentum sum distribution simultaneously.

Autoimmune targets of heart and skeletal muscles in myasthenia gravis

OBJECTIVE

To investigate the clinical, histological, and immunological features of patients with myasthenia gravis (MG) who also developed myocarditis and/or myositis.

DESIGN

Observational and retrospective case series.

SETTING

Keio University, Hanamaki General Hospital, Kanazawa University, Nagasaki University, and Juntendo University.

PATIENTS

A cohort of 8 patients with MG with clinically defined inflammatory myopathies.

INTERVENTIONS

Clinical and histological features were described. Serological analyses included MG-related antistriational autoantibodies (those to titin, ryanodine receptor, muscular voltage-gated potassium channel Kv1.4) and myositis-specific autoantibodies.

RESULTS

Of 924 patients with MG, 8 (0.9%) had inflammatory myopathies. The mean (SD) onset age of MG was 55.3 (10.3) years. All patients showed severe symptoms with bulbar involvement; 5 patients had myasthenic crisis and 4 had invasive thymoma. Myocarditis was found in 3 patients and myositis in 6. Myocarditis, developing 13 to 211 months after the MG onset, was characterized by heart failure and arrhythmias. Myositis, developing before or at the same time as MG, affected limb and paraspinal muscles. Histological findings of skeletal muscles showed CD8(+) lymphocyte infiltration. Seven patients had 1 of these antistriational autoantibodies but not myositis-specific autoantibodies. Immunomodulatory therapy was required for all patients and was effective for both MG and inflammatory myopathies, although 1 patient died.

CONCLUSIONS

Heart and skeletal muscles are autoimmune targets in some patients with MG. This autoimmunity has a broad clinical spectrum with antistriational autoantibodies.

Fine positioning of a poloidal probe array

Multipoint detection is an essential requirement for investigating plasma turbulence which is a highly nonlinear phenomenon in space and time. We have fabricated an array of 64-channel poloidal probes surrounding the linear cylindrical plasma named LMD-U in order to study turbulence properties, particularly the nonlinear mode couplings, in the domain of poloidal wave number and frequency. However, misalignments of probe tips produce spurious modes, which do not exist in the real plasma, to distort the precise wave number measurements. The paper presents the description of the 64-channel poloidal probe array with means to adjust the probe positions, with discussion on the effects of the misalignments on the wave number measurements.

Is excitation–contraction coupling impaired in myasthenia gravis?

OBJECTIVE

To investigate whether excitation-contraction (E-C) coupling of muscle is impaired in patients with myasthenia gravis (MG).

METHODS

In 51 patients with generalized MG and 35 normal subjects, compound muscle action potentials (CMAPs) of the abductor pollicis brevis, and movement-related potentials using an accelerometer placed at the thumb tip were simultaneously recorded after median nerve stimulation at the wrist. The E-C coupling time (ECCT) was estimated by a latency difference between CMAP and movement-related potential. Antibodies against acetylcholine receptor (AChR), ryanodine receptor (RyR), and muscle specific receptor tyrosine kinase (MuSK) were measured by immunoassays.

RESULTS

The mean ECCT was significantly longer in patients with MG (mean+/-SEM; 2.79+/-0.1 ms; p=0.002) than in normal controls (2.52+/-0.1 ms). Among MG patients, the mean ECCT was longer for patients with thymoma than for those without it (P=0.04), and was shorter for patients treated with FK506 (an immunosuppressant and also an enhancer of RyR related Ca(2+) release) than for those not receiving this treatment (p=0.04). ECCT had no significant correlation with anti-AChR, anti-RyR, or anti-MuSK antibodies.

CONCLUSIONS

In MG, E-C coupling appears to be impaired, particularly in patients with thymoma, and FK506 possibly facilitates E-C coupling.

SIGNIFICANCE

The functional implication of impaired E-C coupling is not established, but it may contribute to muscle weakness in patients with MG.

Use of alum and inactive Bordetella pertussis for generation of antibodies against synthetic peptides in mice

We have investigated the efficacy of the combined use of Alum and inactive Bordetella pertussis (iBP) adjuvants for eliciting anti-peptide antibodies. ICR mice were immunized four times at 3-week intervals with each of 7 free (i.e., not conjugated to any carrier) synthetic peptides of 15-17 amino acid residues in Alum + iBP, in the commonly used adjuvant protocols (CFA; CFA (initial) followed by IFA), or in CFA + iBP. Serum samples after 3 and 4 injections were tested by RIA. Use of Alum + iBP greatly increased the production of antibodies for most of the peptides. The results have important implications for human vaccine formulation involving peptides.

Myasthenia gravis induced in mice by immunization with the recombinant extracellular domain of rat muscle-specific kinase (MuSK)

Myasthenia gravis (MG) is mostly caused by anti-acetylcholine receptor (AChR) auto-antibodies (Abs). Such Abs are undetectable in 10-15% of MG patients, but many have anti-muscle-specific kinase (MuSK) Abs. We injected recombinant rat-MuSK extracellular domain in H-2(a), H-2(b), H-2(bm12) and H-2(d) mice. Certain strains exhibited exercise-induced fatigue, tremors, weight loss, and some died after 2-3 injections. Compound muscle action potentials showed decrement with low-frequency repetitive nerve stimulation. Miniature endplate potentials decreased, suggesting lower numbers of endplates functional AChRs. Myasthenic sera inhibited agrin-induced AChR aggregation in C2C12 myotubes.

CONCLUSION

Anti-MuSK Abs induce MG, which might also result from blocking the agrin-signaling pathway.

Voglibose inhibits postprandial hypotension in neurologic disorders and elderly people

The authors examined blood pressure, glucose, insulin, and neurotensin before and after intake of 75 g glucose with or without voglibose in 28 neurologic patients and 20 healthy controls. Voglibose significantly prevented hypotension and neurotensin increment after glucose intake and had no influence on glucose or insulin increment. These results suggest that voglibose benefits postprandial hypotension.

Elevation of IL-12 p40 and its antibody in myasthenia gravis with thymoma

We examined the serum levels of cytokines, interferon (IFN)-alpha, IFN-gamma, interleukin (IL)-4, IL-12 p40, and IL-12 p70; those that affect the T helper 1 and 2 balance in patients with myasthenia gravis (MG). Among the cytokines tested, only IL-12 p40, together with the serum titer of anti-IL-12 p40 antibody, was significantly elevated in MG with thymoma. Their elevation was independent of the histopathology of thymoma. Thymectomy decreased the levels of IL-12 p40 accompanied by the anti-acetylcholine receptor antibody, but not anti-IL-12 p40 antibodies. These data strongly suggest the association of IL-12 p40 and its autoantibody with the immunopathology of MG with thymoma.

Inhibition by human sera of botulinum neurotoxin-A binding to synaptosomes: A new assay for blocking and non-blocking antibodies

The mouse protection assay (MPA), which is an in vivo assay, is currently the most widely used method for monitoring blocking antibodies (Abs) in botulinum neurotoxin (BoNT)-treated patients. In recent studies we found that a number of the regions on the heavy (H) subunit of BoNT/A that bind blocking mouse Abs coincided, or overlapped, with the regions that bind to mouse synaptosomes (snps). This suggested that blocking anti-BoNT/A Abs would be expected to inhibit BoNT/A binding to snps. In the present work, we analyzed sera from 58 cervical dystonia (CD) patients who had been treated with BOTOX (a preparation of BoNT/A serotype) for blocking Abs by MPA and by their abilities to inhibit in vitro the binding of 125I-labeled active BoNT/A or inactive toxin (toxoid) to mouse brain snps. With active 125I-labeled BoNT/A-snps binding, the MPA-positive sera (n = 30) displayed inhibition levels that were distinctly higher (mean = 21.1 +/- 5.8) than those obtained with MPA-negative sera (n = 28) (mean = -1.3 +/- 3.9; p < 0.0001) or control sera (n = 19) (mean = -3.4 +/- 2.8; p < 0.0001). Similarly, inhibition levels by MPA-positive sera of 125I-labeled toxoid snp-binding (mean = 48.6 +/- 8.7) were distinctly higher than inhibition by MPA-negative sera (mean=10.0+/-7.6; p < 0.0001) or control sera (mean = 1.8 +/- 6.9; p < 0.0001). Thus, using labeled active toxin or toxoid, the inhibition assay correlated very well with the MPA. The inhibitory activity of the non-protective sera generally correlated with the duration of survival after toxin challenge (correlation coefficients of inhibition: active toxin = 0.445; p = 0.0167; inactive toxoid = 0.774; p < 0.0001). It is concluded that the snp-inhibition assay reported here is reliable, reproducible and correlates very well with the MPA. It requires much less serum (0.75% of the amount needed for the MPA) and is considerably less costly than the MPA. With either 125I-labeled active toxin or toxoid, it is possible to distinguish CD sera that have blocking Abs from those that lack such Abs. Since the results with the toxoid were as discriminating as those of the active toxin, it would not even be necessary to use active toxin in these assays.

Exclusive measurement of the nonmesonic weak decay of the lambda(5)He hypernucleus

We performed a coincidence measurement of two nucleons emitted from the nonmesonic weak decay of lambda(5)He formed via the 6Li(pi+, K+) reaction. The energies of the two nucleons and the pair number distributions in the opening angle between them were measured. In both np and nn pairs, we observed a clean back-to-back correlation coming from the two-body weak reactions of lambda p --> np and lambda n --> nn, respectively. The ratio of the nucleon pair numbers was N(nn)/N(np) = 0.45 +/- 0.11(stat) +/- 0.03(syst) in the kinematic region of cos theta(NN) < -0.8. Since each decay mode was exclusively detected, the measured ratio should be close to the ratio of gamma(lambda p --> np)/gamma(lambda n --> nn). The ratio is consistent with recent theoretical calculations based on the heavy meson and/or direct-quark exchange picture.

Vaccination with a MHC class II peptide in Alum and inactive pertussis strongly ameliorates clinical MG in C57BL/6 mice

We have investigated the efficacy of immunization against peptides from predisposing MHC class II molecules in human-compatible adjuvants for ameliorating experimental autoimmune myasthenia gravis (EAMG). C57BL/6 mice were immunized three times with the peptide I-Abetab62-76 in Alum+killed pertussis organisms (PT) prior to two injections with tAChR. The treatment greatly reduced the occurrence and severity of clinical MG relative to controls that received saline/Alum+PT or none. It also reduced antibody and T-cell responses against tAChR. The results have important implications for the possible immunotherapy of MG by targeting disease-associated MHC.

Multiple pancreatic metastases from clear cell renal carcinoma: Diagnosis with chemical shift magnetic resonance imaging before surgery

We present a case in which multiple pancreatic tumours were diagnosed as metastatic clear cell renal carcinomas with chemical shift MRI (CSI) before surgery. Radiologists may be unable to recognize the loss of intensity on CSI macroscopically. We believe that it is useful to make subtraction images and calculate signal intensity on CSI, even if the lesions are multiple metastatic tumours.

Evidence for a kaon-bound state K(-)pp produced in K(-) absorption reactions at rest

We have searched for a deeply bound kaonic state by using the FINUDA spectrometer installed at the e(+)e(-) collider DAPhiNE. Almost monochromatic K(-)'s produced through the decay of phi(1020) mesons are used to observe K(-) absorption reactions stopped on very thin nuclear targets. Taking this unique advantage, we have succeeded to detect a kaon-bound state K(-)pp through its two-body decay into a Lambda hyperon and a proton. The binding energy and the decay width are determined from the invariant-mass distribution as 115(+6)(-5)(stat)(+3)(-4)(syst) MeV and 67(+14)(-11)(stat)(+2)(-3)(syst) MeV, respectively.

Production of the neutron-rich hypernucleus 10LambdaLi in the (pi-,K+) double charge-exchange reaction

In order to produce a neutron-rich Lambda hypernucleus for the first time, we carried out an experiment by utilizing the (pi-,K+) double charge-exchange reaction on a 10B target. We observed the production of a 10LambdaLi hypernucleus. The cross section for the Lambda bound region was found to be 11.3+/-1.9 nb/sr with the 1.2 GeV/c incident momentum, which is compared with the 10LambdaB hypernucleus production cross section, 7.8+/-0.3 microb/sr, in the (pi+,K+) reaction with a 1.05 GeV/c incident momentum beam.

Mapping of the Synaptosome-Binding Regions on the Heavy Chain of Botulinum Neurotoxin A By Synthetic Overlapping Peptides Encompassing the Entire Chain

The purpose of this work was to map, on the heavy (H) chain of botulinum neurotoxin A (BoNT/A), the regions that bind to mouse brain synaptosomes (snps). We prepared 60 synthetic overlapping peptides that had uniform size and overlaps and encompassed the entire H chain (residues 499 to 1296) of BoNT/A. The ability of each peptide to inhibit the binding of 125I-labeled BoNT/A to mouse brain snps was studied. The binding of 125I-labeled BoNT/A to mouse brain snps was completely inhibited by free unlabeled BoNT/A, but not by unrelated proteins, indicating that the binding of BoNT/A to mouse brain snps was a specific event. Inhibition studies with the individual peptides showed that, on the H(N) domain, inhibitory activities greater than 10% were exhibited, in decreasing order, by peptides 799-817, 659-677, 729-747, 533-551, 701-719, and 757-775. Lower inhibitory activities (between 5.6% and 8.7%) were exhibited by five other peptides, 463-481, 505-523, 519-537, 603-621 and 645-663. The remaining 18 H(N) peptides had little or no inhibitory activity. In the H(C) domain, peptides 1065-1083, 1163-1181 and 1275-1296 had the highest inhibitory activities (between 25% and 29%), followed (10-12% inhibitory activity) by peptides 1107-1125, 1191-1209 and 1233-1251. Two other peptides, 1079-1097 and 1177-1195, had very low (5.8% and 4.9%) inhibitory activities. The remaining 23 H(C) peptides had no inhibitory activity. Inhibition with mixtures of equimolar quantities of the most active 6 peptides of HN, 5 of H(C) or all 11 of H(N) and H(C) revealed that the peptides contain independent non-competing binding regions. Comparison of the locations of the snp-binding regions on the H-subunit with the regions that bind blocking mouse anti-BoNT/A Abs helped explain the protecting ability of these Abs. In the three-dimensional structure of BoNT/A, the snp-binding regions that completely coincide or significantly overlap with the antigenic regions occupy surface locations and most of them reside in the last half of the H(C) domain. But some of the regions reside in the HN domain and might play a role in the translocation event.

Rotation of the spinal cord in idiopathic scoliosis

We undertook a radiographic analysis with pre-operative computed tomographic myelography in 78 patients with idiopathic scoliosis in order to analyse rotation of the spinal cord and to investigate its clinical significance. The angle of rotation of the cord had a statistically significant relationship to both that of the apical vertebra and the size of the primary curve. The relationship between the rotation of the cord and that of the apical vertebra was divided into three types. The cord rotated in the same direction as the apical vertebra in 55 patients and rotated in the opposite direction in the remaining 23 patients. In the first group, the angle of rotation of the cord was more than that of the vertebra in six patients, but less than it in 49 patients. These results suggest that the neuraxis in idiopathic scoliosis may be under tension in the axial dimension.

Unanswered and uncounted items of the illness behavior questionnaire count: a comparison between patients who answered all the items in the questionnaire and those who left one or more items unanswered in a pain management program

PURPOSE

This study aimed to understand the significance of unanswered and uncounted items on the illness behavior questionnaire (IBQ) in the setting of the Mayo Clinic pain management program for patients with chronic pain.

METHODS

Three hundred and seventy-eight patients who completed the questionnaire were studied. The data included (1) age, (2) IQs, (3) IBQ score profiles, (4) litigation status, (5) admission status (inpatient vs outpatient), and (6) dismissal status ("graduates" vs "dropouts").

RESULTS

Comparison between patients who answered all the items (n = 272) and those who left one or more items unanswered (n = 106) showed a significant difference in the completion rate of the Wechsler Adult Intelligence Scale ( P < 0.05), Scale 5 (affective disturbance) score (P < 0.05), and the rate of dropout from the program (P < 0.05). Also, those who dropped out of the pain management program had a significantly lower score on Scale 5 (P < 0.001) and a significantly greater number of unanswered items that were not counted toward the scale score (P < 0.05).

CONCLUSION

Unanswered and uncounted items of the IBQ seem to count toward a better understanding of patients' pain behavior.

Immunoadsorption in myasthenia gravis based on specific ligands mimicking the immunogenic sites of the acetylcholine receptor

A specific system for antibody removal from blood circulation in myasthenia gravis (MG) patients was devised by use of the immunoadsorbent bound to an acetylcholine receptor (AChR) peptide that was synthesized corresponding to the sequence of residues 183-200 of the AChR alpha-subunit (alpha 183-200), antibodies which prevent the binding of ACh to AChR. The alpha 183-200 peptide was confirmed to be immunogenic for induction of an animal model of the disease and for reactivity with MG autoantibodies. We then made use of these results for immunoadsorption therapy through the antigen-antibody reaction on the molecular level, having given patients relief from myasthenic weakness. The greatest care was taken for the selection of an antigenic region in the molecular structure among various myasthenogenic domains of AChR and for the antigenic conformation of synthetic peptide as the adsorbent to react with antibodies raised against the native protein.

Clinical significance of serum pulmonary surfactant proteins a and d for the early detection of radiation pneumonitis

PURPOSE

Radiation pneumonitis (RP) is one of the most serious complications for patients who receive thoracic irradiation. To avoid this, early diagnosis of radiation pneumonitis is extremely important. The purpose of the present study is to investigate whether serum pulmonary surfactant proteins A and D (SP-A and SP-D, respectively) could be useful markers for RP.

METHODS AND MATERIALS

Eighty-six patients (lung cancer: 42 [primary: 39, metastatic: 3], breast cancer: 23, esophageal cancer: 21) who underwent radiation therapy were prospectively studied. Radiation doses ranged from 30-76 Gy (median, 58 Gy). Serum SP-A and SP-D levels were evaluated sequentially by a sandwich enzyme-linked immunosorbent assay (ELISA) method before, during, and throughout the follow-up period until the development of symptomatic RP or until one year after completion of radiotherapy. Specificity of the ELISA results was confirmed by Western blot analysis. Patients symptomatic for RP were graded according to the Common Toxicity Criteria.

RESULTS

RP occurred in 19 patients. Serum SP-D levels of patients with RP were sequentially higher than those in patients without RP. In the monitoring, serum SP-D levels at 50-60 Gy showed greater sensitivity and positive predictive values for RP detection (74% and 68%, respectively) than SP-A (26% and 21%, respectively). Western blot analysis showed that the development of RP was due to overproduction, but not proteolysis of surfactant proteins.

CONCLUSION

We confirm that serum SP-A and SP-D monitoring is a practical and useful diagnostic method for the early detection of RP.

Pilot study of local radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma

BACKGROUND

Patients suffering from hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) generally have a poor prognosis. We therefore conducted a prospective pilot trial of combined transcatheter arterial chemoembolization (TACE) and local radiotherapy (RT) for PVTT in unresectable HCC. The aim of the study was to investigate the efficacy and toxicity of this preliminary trial regime and to explore RT guidelines for cirrhosis.

METHODS

Eight patients with unresectable HCC accompanied by first branch PVTT were entered into the study from February 1998 to December 1999. TACE was performed using Lipiodol, epirubicin hydrochloride and mytomycin followed by gelatin sponge cubes. RT was started 10-14 days following TACE. A total delivered dose of 60 Gy was given as daily 2 Gy fractions, with the clinical target volume defined as PVTT only. We observed a relationship between deterioration of liver function and the percent volume of the total liver receiving a dose exceeding 30 Gy (V30).

RESULTS

An objective response was observed in three of the eight patients. However, on follow-up angiograms the protrusion of PVTT into the main portal trunk was decreased in all cases. Deterioration of liver function was observed in all patients with V30 >40%.

CONCLUSION

It is possible that this combined therapy prevents PVTT from spreading to the main trunk and that indicates a further benefit of TACE. Our results indicate that V30 constitutes a predictive test for the development of liver failure. More detailed evaluations of liver function and determination of the safe irradiation volume are necessary.

Key factors influencing bowel function after ileal W-pouch anal anastomosis: a spectral analysis of W-pouch motor activity

Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) has become the standard surgical procedure for ulcerative colitis (UC). The purpose of this study was to determine which factors are important to achieve good anal continence after IPAA in terms of the motor activity and pressure-volume relationship. A total of 17 patients with UC who underwent IPAA were evaluated. The internal ileal pouch pressure was transanally measured with and without volume-loading of the pouch which induces the urge to evacuate. The maximum tolerable volume (MTV), first urge volume (FUV), and ileal pouch compliance were calculated and the internal ileal pouch pressure records were subjected to spectral analysis for intensive evaluation of the intraluminal pressure waves. The FUV, correlation of the compliance of the FUV with MTV, and the remaining volume up to the MTV (RVMTV) were analyzed. Compliance of the FUV was significantly correlated with the RVMTV (r = 0.736, P < 0.01). The frequency of the phasic waves in the pouch decreased with length of follow up, reflecting improved function (r = -0.588, P < 0.05). The findings of this intensive analysis of manometric measurement indicate that the key factors in postoperative pouch function are RVMTV and the frequency of phasic waves in the W-pouch.

[Receptor diseases in the field of neurology]

Based on the gene-related function and molecular structure of various receptors, neurological receptor diseases were reviewed from both the immunologic and genetic perspectives. The nicotinic acetyl-choline receptor (AChR), ryanodine receptor (RyR), omega-conotoxin receptor (P/Q-type voltage-gated calcium channel), dihydropyridine receptor (L-type voltage gated calcium channel), and androgen receptor have been found to be affected by autoantibodies and/or genetic anomalies. They reflect on various neurological diseases such as myasthenia gravis, congenital myasthenic syndrome, malignant hyperthermia and central core disease, paraneoplastic myasthenic syndrome, hereditary migraine and ataxias, hypokalemic periodic paralysis, and bulbospinal muscular atrophy. The interaction of calcitonin gene-related peptide with its receptor tends to compensate the dysfunction caused by antibodies to AChR and RyR. One should look for cancers or genetic disorders in the case of the receptor disease implicated in calcium channel function. Recent advances in search for the etiology of these diseases from the standpoints of immunology and genetics have opened an avenue in understanding the functional structure of receptors and the molecular sites responsible for receptor diseases.

Lambert-Eaton myasthenic syndrome as an autoimmune calcium-channelopathy

Lambert-Eaton myasthenic syndrome (LEMS), often associated with small cell lung carcinoma (SCLC), is a disease of neuromuscular transmission in which antibodies directed against voltage-gated calcium channel (VGCC) in the motor nerve terminal play a crucial role in causing a deficient quantal release of acetylcholine. We focused attention on the P/Q-type VGCC, against which a majority of LEMS patients carry the specific antibody. Since the P/Q-type VGCC expresses in SCLC, the motor nerve terminal and SCLC may share a common VGCC antigen. In search for antigenic sites at the molecular level, We employed peptides or recombinant protein corresponding to the S5-S6 linker of each of four domains forming the alpha 1A subunit and tested their antigenicity. As the result, we specified the domain II, III and IV as immunodominant sites by the induction of an immune-mediated animal model of LEMS and the assay for antibodies in LEMS patients. Also, by use of peptides or recombinant protein corresponding to the synaptotagmin I, we found that in this VGCC-associated protein, the segment which exposes extracellularly during exocytosis can be antigenic for LEMS.

Optimists vs pessimists: survival rate among medical patients over a 30-year period

OBJECTIVE

To examine explanatory style (how people explain life events) as a risk factor for early death, using scores from the Optimism-Pessimism scale of the Minnesota Multiphasic Personality Inventory (MMPI).

SUBJECTS AND METHODS

A total of 839 patients completed the MMPI between 1962 and 1965 as self-referred general medical patients. Thirty years later, the vital status of each of these patients was ascertained.

RESULTS

Of the 839 patients, 124 were classified as optimistic, 518 as mixed, and 197 as pessimistic. Follow-up was available for 723 patients. Among these, a 10-point T-score increase on the Optimism-Pessimism scale (e.g., more pessimistic) was associated with a 19% increase in the risk of mortality.

CONCLUSION

A pessimistic explanatory style, as measured by the Optimism-Pessimism scale of the MMPI, is significantly associated with mortality.

Target cells of apoptosis in the adult murine dentate gyrus and O4 immunoreactivity after ionizing radiation

The occurrence of radiation-induced apoptosis and the determination of target cells were investigated by using the TdT-mediated dUTP-biotin nick end labeling assay and immunohistochemical analyses. The O4 immunoreactivity, an oligodendrocytes surface antigen, was also evaluated by using western blotting analysis. C57BL/6J adult female mice were subjected to single dose irradiation of 10 Gy. Eight hours after irradiation, the most significant increase of apoptotic cells was detected in the subgranular zone and the hilus of the dentate gyrus. The target cells of radiation-induced apoptosis are the subgranular progenitor cells and the oligodendrocytes in the hilus. The amount of the O4 immunoreactivity, a marker for premature oligodendrocytes, was unchanged until 8 h but enhanced after 12 h of irradiation. These results are the first to show the increase of the O4 immunoreactivity after irradiation and may be associated with the pathogenesis of radiation injury.

Isopower maps of the electrogastrogram (EGG) after total gastrectomy or total colectomy

Isopower or topographic electrogastrograms (EGG) correspond to topographic electroencephalograms. Both project the topographic localizations of the spectral frequencies on the abdominal surface or scalp. This paper compares the pre-operative control isopower EGG maps with those of total gastrectomy or total colectomy. EGGs were recorded simultaneously at 27 locations on the epigastro-abdominal surface. Spectral analysis by the maximal entropy method (MEM) was performed and the ensemble means of pre-prandial and post-prandial spectra were calculated. The spectral frequencies were arbitrarily classified into five groups, 1 cycle per minute (cpm) (0-2.4 cpm), 3 cpm (2.5-4.9 cpm), 6 cpm (5.0-7.4 cpm), 8 cpm (7.5-9.9 cpm) and 10 cpm (10.0-12.9 cpm). Maximal power peaks in each spectral group, and electrode locations which were expressed by x-y coordinates were the indicators for making the isopower EGG maps by using a contour map program. Thereafter, the maximal power spots or foci in each spectral group were determined. The pre-operative maximal power foci of the 1, 8 and 10 cpm groups were distributed rather evenly on the epigastro-abdominal surface. Those of the 3 and 6 cpm groups, mainly concentrated in the epigastric region, were absent in almost all patients who had undergone total gastrectomy. The infra-umbilical foci of the 3 and 6 cpm groups completely disappeared after total colectomy. The infra-umbilical foci of the 3 and 6 cpm groups (2.5-7.4) may reflect the colonic activities and the epigastric 3 cpm foci, the gastric activities. The pre-operative maximal power of the 3 cpm foci decreased significantly after total or sub-total gastrectomy.

Expression of pulmonary mRNA encoding ICAM-1, VCAM-1, and P-selectin following thoracic irradiation in mice

PURPOSE

Recent studies have revealed that ionizing radiation induces the expression of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and P-selectin in vitro. The purpose of this study was to investigate the expression of these adhesion molecules in mouse lung following whole thoracic irradiation.

MATERIALS AND METHODS

C57BL/6J mice were irradiated with a single dose of 12 Gy to the thoraces and sacrificed at 4, 12, 24, and 48 hours and 1, 2, 4, and 8 weeks after irradiation. Expression of total lung mRNA for ICAM-1, VCAM-1, and P-selectin was quantified by the Northern blot method and normalized to beta-actin.

RESULTS

There were increases in mRNA for ICAM-1 of 42% at 4 hours (p < 0.05), 76% at 24 hours (p < 0.01), and 51% at 48 hours (p < 0.05) compared with the controls. These returned to the control level at 1 week. The expression of VCAM-1 mRNA was also increased by 49% (p < 0.01) at 12 hours and was still increased by 25% at 1 week. P-selectin mRNA was transiently increased by 59% at 12 hours.

CONCLUSIONS

These early inductions of mRNA for ICAM-1, VCAM-1, and P-selectin in mouse lung following thoracic irradiation were transient but significant, and are one of the most immediate changes reported in vivo.