Chronic Clinical Findings after Rheocarna® Therapy in a Chronic Limb-threatening Ischemia Patient with Inframalleolar Lesions: A Case Report

An 87-year-old man was referred to our hospital for non-healing ulcers on the right third, fourth, and fifth toes. The patient was diagnosed with chronic limb-threatening ischemia. Pre-treatment angiography of the right lower extremity revealed inframalleolar lesions. We failed to perform endovascular treatment because of severe calcification. Therefore, we treated the patient with a novel low-density lipoprotein apheresis device (Rheocarna®; Kaneka Corporation, Osaka, Japan). Angiography performed four days after therapy revealed significant improvement in microcirculation. One year after therapy, he managed to avoid major amputation and achieve wound healing. In addition, angiography revealed that the microcirculation was maintained.

Rheocarna® as an alternative therapeutic option for patients with chronic limb-threatening ischemia: A case report

Recently, a new low-density lipoprotein apheresis device (Rheocarna^®; Kaneka Corporation, Osaka, Japan), a blood purification therapy, was approved in Japan for managing chronic limb-threatening ischemia with refractory ulcers. Here, we describe a case of chronic limb-threatening ischemia that was treated with the Rheocarna. A 65-year-old Asian man with an ulcer on the right heel was admitted to our hospital. Angiography revealed chronic total occlusion with severe calcification of the anterior tibial, peroneal, and posterior tibial arteries. The patient underwent distal bypass of the saphenous vein; however, the bypass was occluded in the early postoperative period. The Rheocarna was used, and the ulcers improved significantly postoperatively. Although endovascular treatment was eventually performed on the occluded bypass graft to completely heal the ulcer, the Rheocarna could be an alternative treatment option in challenging cases of chronic limb-threatening ischemia.

Clinical Outcomes and Predictors of All-Cause Mortality After Complex High-Risk and Indicated Revascularization Using Percutaneous Coronary Intervention

The concept of complex and high-risk indicated procedures using percutaneous coronary intervention (CHIP-PCI) has recently been defined. However, few studies have investigated the prognosis of patients after CHIP-PCI. We enrolled 322 consecutive patients who underwent CHIP-PCI. CHIP-PCI was defined as a procedure satisfying at least one criterion each for both patient and procedure characteristics, as follows: patient characteristics [age ≥ 75 years old, low left ventricular ejection fraction (LVEF), diabetes mellitus, acute coronary syndrome, previous coronary artery bypass surgery, peripheral arterial disease, severe chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and severe valvular disease] and procedure characteristics [unprotected left main disease, degenerated saphenous or radial artery grafts, severely calcified lesions, last patent conduit, chronic total occlusions, multivessel disease, and use of mechanical circulatory support]. On Kaplan-Meier analysis, 1-, 2-, and 3-year survival rates following CHIP-PCI was 93.8%, 89.2%, and 85.4%, respectively. Moreover, on Cox multivariate hazard analysis, age (≥ 75 years old) (hazard ratio: 4.01, 95% confidence interval: 1.92-8.38, P < 0.01), COPD (hazard ratio: 2.95, 95% confidence interval: 1.38-6.32, P < 0.01), low LVEF (hazard ratio: 3.35, 95% confidence interval: 1.55-7.22, P < 0.01), severe CKD (hazard ratio: 3.02, 95% confidence interval: 1.44-6.36, P < 0.01), and use of mechanical circulatory support (hazard ratio: 5.97, 95% confidence interval: 2.72-13.10, P < 0.01) remained significant predictors of mortality. In conclusion, we revealed the clinical outcomes after CHIP-PCI. The presence of advanced age, COPD, low LVEF, severe CKD, and mechanical circulatory support use might lead to worse clinical outcomes.

Cryoballoon ablation for atrial fibrillation without the use of a contrast medium: a combination of the intracardiac echocardiography and pressure wave monitoring guided approach

In cryoballoon ablation (CBA), a contrast medium is commonly used to confirm balloon occlusion of the pulmonary veins (PVs). However, a contrast medium cannot always be used in patients with renal dysfunction and allergy. The present study aimed to assess the efficacy and safety of CBA without the use of a contrast medium. We retrospectively examined consecutive patients with paroxysmal atrial fibrillation (PAF) who underwent first-time CBA. We compared the procedural results and outcomes in patients for whom a contrast medium was used (contrast group) and those from whom a contrast medium was not used (non-contrast group). In the non-contrast group, we used saline injection on the intracardiac echocardiography and pressure wave monitoring for PV occlusion. Fifty patients (200 PVs) and 22 patients (88 PVs) underwent CBA with and without a contrast medium, respectively. The success rate of PV isolation with CBA alone was 93% and 90% in the non-contrast and contrast groups, respectively (p = 0.40). The fluoroscopy time and nadir temperature were significantly lower in the non-contrast group as compared to that in the contrast group. The recurrence rate 1 year after ablation did not differ between the two groups (18% vs. 18%, p > 0.99). Furthermore, the number of reconnected PVs in patients with recurrence was significantly lower in the non-contrast group than in the contrast group (6% vs. 36%, p = 0.017). In conclusion, CBA using the intracardiac echocardiography and pressure monitoring approach without the use of a contrast medium was safe and efficient.

Impact of the clinical frailty scale on clinical outcomes and bleeding events in patients with ST-segment elevation myocardial infarction

The Clinical Frailty Scale (CFS) is a simple tool to assess patients' frailty and may help to predict adverse outcomes in elderly patients. The aim of the present study was to examine the impact of CFS on clinical outcomes and bleeding events after successful percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). We enrolled 266 consecutive patients with STEMI who underwent primary PCI in between January 2015 and June 2018. Patients were categorized into two groups based on the CFS stages: CFS 1-3 and CFS ≥ 4. We collected the data and evaluated the relationship between the CFS grade and the incidence of major adverse cardiovascular events (MACE) and Bleeding Academic Research Consortium 3 or 5 bleeding events. Of these patients, CFS ≥ 4 was present in 59 (22.2%). During the follow-up, 37.3% in the CFS ≥ 4 group and 8.2% in the CFS 1-3 group experienced MACE. In Kaplan-Meier analysis, the proportion of MACE-free survival for 4 years was significantly lower in the CFS ≥ 4 group (log-rank P < 0.001). Additionally, the proportion of bleeding event-free survival was significantly lower in the CFS ≥ 4 group (log-rank P < 0.001). The CFS (per 1-grade increase) remained an independent significant predictor of MACE on multivariate Cox proportional hazard analysis [hazard ratio 1.39 (95% confidence interval: 1.08 to 1.79, P = 0.01)]. In conclusion, CFS was an independent predictor of future adverse cardiac events in patients with STEMI. Therefore, the assessment of CFS is crucial in this population.

Disappearance pattern and the last remaining earliest pulmonary vein potential during cryoballoon ablation in predicting recurrence and conduction gap site of pulmonary veins

Electrophysiological studies have rarely evaluated the sites prone to pulmonary vein (PV) conduction gap during cryoballoon ablation (CBA) for atrial fibrillation (AF). In addition, no studies have analyzed the sequence of PV potentials just before PV isolation during CBA for AF. Of the 238 patients who underwent first-time CBA for paroxysmal AF, 115 PVs of 29 patients who underwent repeat session due to recurrence after the procedure were retrospectively evaluated in the study. We evaluated the disappearance pattern of PV potential and PV reconnection on intracardiac electrograms and investigated whether the conduction gap site of the PV was related to the last remaining earliest PV potential (EP) and sequence pattern during the first-time CBA. Time to isolation was observed in 81 PVs during the first-time CBA. At the repeat session, PV reconnection was only observed in 22 of 81 PVs. PV potentials disappeared with sequence changes in 36 PVs and without sequence changes in 38 PVs. Multivariate analysis demonstrated that disappearance of PV potentials without change in the EP site but with delay or disappearance of other PV potentials was independently associated with PV reconnection (12/22 PVs [55%] vs. 4/59 PVs [6.8%]; odds ratio 14.4; 95% confidence interval 3.75-55.5; p < 0.001). In 19 of 22 (86%) reconnected PVs, PV conduction gap sites at repeat ablation corresponded with the last remaining EP sites during first-time CBA. In conclusion, disappearance pattern of the PV potential and the last remaining EP during the CBA can predict PV reconnection and gap site.

Muse cells, endogenous reparative pluripotent stem cells, are mobilized into the peripheral blood after percutaneous coronary intervention in patients with coronary artery disease

Background

Multilineage-differentiating stress enduring (Muse) cells, endogenous reparative pluripotent stem cells, are defined as stage-specific embryonic antigen 3+ (SSEA3+) and CD105+ double-positive cells. We previously reported that intravenously injected Muse cells home to the damaged heart and differentiate into cardiomyocytes and vessels, and reduce the infarct size and improve cardiac function in a rabbit model of acute myocardial infarction (AMI) (Circ Res 2018), and that endogenous Muse cells are mobilized into the peripheral blood in the acute phase of patients with AMI, which improve left ventricular (LV) function and attenuate LV remodeling in the chronic phase at 6 months (Circ J 2018). However, whether Muse cells are mobilized into the peripheral blood after percutaneous coronary intervention (PCI) in patients with coronary artery disease.

Methods

Muse cells in the peripheral blood was measured by fluorescence-activated cell sorting (FACS) as SSEA3+ and CD105+ double-positive cells in patients with coronary artery disease with 75% coronary stenosis who underwent PCI (n=18) with a mean age of 73.0±7.2 (14 male and 4 female). Blood samples were collected from the antecubital vein in patients with coronary artery disease before, and 1 and 24 h after PCI. Since the majority of Muse cells were detected in the monocyte area and few Muse cells if any were detected in the lymphocyte area, we counted the Muse cells in the monocyte area by FACS. The number of Muse cells was expressed as cells per 100 μL of blood, as follows: absolute number of Muse cells (/100 μL) = white blood cells (/100 μL) × monocytes (%) × SSEA3+/CD105+ double-positive cells (%).

Results

Typical case of SSEA3+/CD105+ double-positive Muse cells measured by FACS shows that majority of Muse cells exist in the monocyte area (Fig, 1-A). The number of Muse cells in the peripheral blood was significantly greater (p&lt;0.05) at 1 h (58.6±23.8 /100 μL) or 24 h after PCI (69.7±43.1/100 μL) as compared with that before PCI (46.3±19.0/100 μL) (Fig. 1-B).

Conclusion

Muse cells, endogenous pluripotent stem cells, are mobilized into the peripheral circulating blood 1 h and 24 h after PCI in patients with coronary artery disease. Mobilized Muse cells after PCI might be contributing to repair the damaged coronary artery.

Figure 1

Funding Acknowledgement

Type of funding source: None

[Multilocular thymic cyst]

We describe a case of multilocular thymic cyst with severe acute inflammation. A 23-year-old man was admitted to our hospital with a sudden onset of chest pain and high fever. A computed tomography scan showed multilocular cystic lesion at anterior mediastinum. We resected the tumor with the thymus by median sternotomy. Macroscopically, the mediastinal mass showed thick-walled multiloculated cavities filled with turbid yellow fluid. Histological examination revealed that the tumor was a multilocular thymic cyst which is reported by Suster.

[Tension hemothorax associated with congenital pulmonary arteriovenous fistula]

We describe a case of intrapleural rupture of pulmonary arteriovenous fistula A 37-year-old woman was admitted to our hospital with a sudden onset of right chest pain. A computed tomography scan showed massive pleural effusion and tension hemothorax. Subsequently the patient went into shock. Partial resection of the lung was performed emergently. Pulmonary arteriovenous fistula is often associated with Rendu-Osler-Weber disease (ROW). Because of her brain arteriovenous malformation and family history, we could not exclude the possibility of ROW.

Long-term outcome after allogeneic bone marrow transplantation for hematological malignancies with non-remission status. Results of a single-center study of 24 patients

To investigate the problem of allogeneic bone marrow transplantation (allo-BMT) for advanced stage patients, we retrospectively analyzed 24 consecutive patients who underwent allo-BMT in the non-remission stage. Twenty-four patients (19 males and 5 females) with acute leukemia, chronic myelogenous leukemia, and malignant lymphoma underwent allo-BMT. The patients had a median age of 30 years. There were eight cases of acute myelogenous leukemia (AML), six cases acute lymphocytic leukemia (ALL), nine cases of chronic myelogenous leukemia (CML), and one case of Burkitt's lymphoma. The 3-year overall survival rate was 22.5%, with a median survival time of 206 days in AML, 345 days in ALL, and 363 days in CML. Overall survival was associated with a recovery of platelets of less than 30 days and an acute graft-versus-host disease (acute GVHD) presence of less than grade II ( p=0.042). Fourteen patients died of transplantation-related diseases. Our important problem is to decrease transplantation-related deaths in allo-BMT during the non-remission stage, and longer survival can be expected with better pretreatment and prophylaxis for GVHD. In addition, the selection of the source of hematopoietic stem cell transplantation at an optimal time is considered to be another problem to be approached.

Isolation, culture, and characterization of endocrine cells from 6-month-old porcine pancreas

Porcine endocrine cells were isolated from pancreas of 6-month-old pigs by two-step enzymatic digestion procedures. They were separated by the density gradient (isopycnic) centrifugation method using Histopaque-1077. Isolated cells were cultured and divided into two groups: suspension cells and adhesion cells. Suspension cells maintained their cell numbers on and after 7 days in culture. Approximately 1 x 10(7) cells were obtained from single pancreas of a 6-month-old pig. The cultured suspension cells took up dithizone (DTZ) staining 14 days after isolation in culture and indicated the presence of beta-cells. In in vitro study, the suspension cells were capable of secreting insulin into the culture medium. The suspension cells were tested for insulin and glucagon staining by Western blot analysis. These results indicated the maintenance of endocrine cell function after isolation. However, cultured adhesion cells failed to maintain their function during culture. In in vivo study, the suspension cells were transplanted into diabetes-induced nude mice. Reduction in blood glucose level was obtained after transplantation. Intraperitoneal glucose tolerance test (IPGTT) results showed a normal pattern of blood glucose clearance. After 1 week, the transplanted endocrine cells were detected with anti-insulin antibody by immunostaining and it showed the presence of viable beta-cells under the renal capsule of nude mice. Collectively, our results suggest that isolated and cultured suspension porcine endocrine cells maintained their endocrine function. These endocrine cells can be used as isolated islets for further study, including transplantation experiments.

Evaluation of insulin secretion of isolated rat islets cultured in extracellular matrix

Islet isolation involves enzymatic digestion of the interstitial matrix and mechanical disruption of the tissue. It is possible that a fundamental change of islet biology resulting from the loss of critical factors required for islet function or survival will occur. Extracellular matrix (ECM) is one of the most important components of the islet microenvironment. Reconstruction of the cell-matrix relationship seems to be effective for improving the loss of differentiated islet structure and function. The purpose of this study was to characterize and compare the effects of collagen gel mixture or Matrigel on beta-cell function and islet cell survival. After isolation by the collagenase digestion technique, rat islets were divided and cultured with various types of collagen gel mixture. They were assessed for their glucose-stimulated insulin secretion and cell viability. Glucose-induced insulin secretion of islets cultured with collagen type I gel or a mixture of collagen type I and IV was improved after 11 days in culture. In conclusion, a type of gel composed of collagen type I and/or type IV as an islet microenvironment is sufficient to maintain glucose responsiveness and may be useful for islet transplantation.

Development of a new method to induce angiogenesis at subcutaneous site of streptozotocin-induced diabetic rats for islet transplantation

The subcutaneous space is a potential site for clinical islet transplantation. Even though there are several advantages, poor blood supply at this site mainly causes failure of islet survival. In this study, angiogenesis was induced in advance at the diabetic rats subcutis for islet transplantation by implanting a polyethylene terephthalate (PET) mesh bag containing gelatin microspheres incorporating basic fibroblast growth factor (bFGF) (MS/bFGF) and a collagen sponge. The bFGF was incorporated into gelatin microspheres for controlled release of bFGF. As controls, a PET mesh bag with or without either collagen sponges or MS/bFGF was implanted at the subcutaneous site of diabetic rats. Macroscopic and microscopic examinations revealed the formation of capillary network in and around the PET mesh bag containing MS/bFGF and collagen sponges 7 days after implantation when compare with other control groups. When tissue hemoglobin level was also measured, a significantly high level of hemoglobin amount was observed compared with that of control groups. When allogeneic islets mixed with 5% agarose were transplanted into the prevascularized rat subcutis, normoglycemia was maintained for more than 40 days, while other control groups were ineffective. This study demonstrated that combination of gelatin microspheres incorporating bFGF and collagen sponges enabled the mesh to induce neovascularization even at the subcutaneous site of streptozotocin-induced diabetic rats, resulting in improved function of islet transplantation.

Synthesis of bipyridylene-bridged bisporphyrin by nickel-mediated coupling reaction: ON-OFF control of cofacial porphyrin unit by reversible complexation

Novel bipyridylene-bridged bisporphyrin 1a, in which two porphyrin units were attached directly to symmetrical 4,4'-positions of the 2,2'-bipyridyl group, was synthesized by a nickel(0)-mediated homocoupling reaction of 5,10,15-tris(n-heptyl)-20-(2'-bromo-4'-pyridyl)porphyrinatozinc (3a) in 58% yield. Spatial geometries of two porphyrins in 1a were regulated by reversible complexation of the bipyridyl part with PdCl(2). Thus, the addition of 2.2 equiv of palladium chloride to 1a converted the freely rotating conformation to the cofacial bisporphyrin 2a. The subsequent addition of 4,4'-dimethyl-2,2'-bipyridine 9 regenerated the initial bisporphyrin 1a.

Artificial ion channels showing rectified current behavior

Voltage-dependent artificial ion channels 3 and 4 were synthesized. Two cholic acid derivatives were connected through a m-xylylene dicarbamate unit at 3-hydroxyl groups. Asymmetries were introduced by terminal hydrophilic groups, carboxylic acid and phosphoric acid for 3 and hydroxyl and carboxylic acid for 4. Under basic conditions, these headgroups in 3 and 4 are expected to be dissociate into -1/-2 (pH 8.2) and 0/-1 (pH 7.2), respectively. Single ion channel properties were examined by a planar bilayer lipid membrane method under symmetrical 500 mM KCl at pH 8.2 or 7.2. When 3 and 4 were introduced into the bilayer membrane under application of positive voltage (a positive-shift method), the current values at positive applied voltage were larger than the corresponding ones at the negative applied voltage. The current-voltage plots were fitted by curves through a zero point to show clear rectification properties. The direction of rectification could be controlled by positive- or negative-shift methods. Vectorial alignment of terminal headgroup charges by the voltage-shift incorporation is essential for giving voltage-dependent rectified ion channels.

Variable timing of reproduction in unpredictable environments: adaption of flood plain plants

We study the evolutionarily stable reproductive timing of annual plants that face unpredictable environmental disturbances. Plants living in a riverbed often experience a disturbance before they reproduce, suffering major fitness loss. Plants reproducing prior to the flood season are free from the risk of lost reproduction, but a small flowering plant can produce only a few numbers of seeds. If the date of disturbance is unpredictable, a mixed strategy of reproductive timing may evolve in which individuals of the same genotype have different reproductive dates. We calculate the evolutionarily stable phenotype distribution analytically. Depending on parameters, the ESS distribution is either (1) a timid strategy-the plant reproduces when small, prior to the major disturbance season; (2) a bold strategy-the plant reproduces only when it is fully grown; (3) a mixture of early and late reproduction; or (4) dates of reproduction spread over a wide interval. We also examine the effects of developmental and environmental noises that make realized flowering dates deviate from that programmed by the genotype, which follows the ESS distribution. In the presence of noise, the ESS distribution of programmed timing of reproduction is discrete.

A case of sensory neuropathy associated with childhood Sjögren syndrome

Complications observed in adulthood Sjögren syndrome also occur in the childhood disease and suggest that Sjögren syndrome should be considered as a cause of neuropathy in children. Treatment with corticosteroid is a choice for such cases.

Pollen coupling of forest trees: forming synchronized and periodic reproduction out of chaos

Many of the tree species in mature forests show masting; their reproductive activity has a large variance between years and is often synchronized between different individuals. In this paper, we analyse a globally coupled map model in which trees accumulate photosynthate every year, produce flowers when the energy reserve level exceeds a threshold, and set seeds and fruits at a rate limited by pollen availability. Without pollen limitation, the trees in the forest show independent chaotic fluctuation. Coupling of trees via pollen exchange results in reproduction being synchronized partially or completely over the forest. The whole forest shows diverse dynamical behaviors determined by the values of two essential parameters; the depletion coefficient k and the coupling strength beta. We find perfectly synchronized periodic reproduction, synchronized reproduction with a chaotic time series, clustering phenomena, and chaotic reproduction of trees without synchronization over individuals. There are many parameter windows in which synchronized reproduction of trees shows a stable periodic fluctuation. For perfectly synchronized forests, we can calculate all the Lyapunov exponents analytically. They show that synchronized reproduction of all the trees in the forest can only occur when trees flower at low (but positive) levels in a significant fraction of years, resulting in small fruit sets due to outcrossed pollen limitation. This is consistent with the observation that the distinction between mast years and non-mast years is often not clear cut.

Production of monoclonal antibody and development of enzyme-linked immunosorbent assay for kanamycin in biological matrices

Monoclonal antibodies (MAbs) against kanamycin were prepared by using a kanamycin-bovine gamma-globulin conjugate for the immunization of mice. Splenocytes from BALB/c immunized mice were fused with P3X63Ag8U.1 myeloma cells. This resulted in two hybridoma cell lines. Fifty per cent inhibition concentrations (IC50) for the MAbs were 2 and 5 ng ml-1. One MAb (IC50 = 2 ng ml-1) was named #22 and was used to develop quantitative assays for kanamycin by means of an enzyme-linked immunosorbent assay (ELISA). The detection limit was 0.2 ng ml-1 and the standard deviations were 0.2-4.4% for intra-assay and 0.6-4.7% for inter-assay, respectively. The detection limits using peroxidase were 4 ppb in cattle milk, cattle plasma, cattle urine, swine plasma, swine urine and chicken plasma. Using the MAb #22 produced, a rapid test kit based on an immunochromatographic method was developed. The detection limits using the kit were 50 ppb in cattle milk, cattle plasma, cattle urine and chicken plasma.

Expression of protective protein in human tissue

The authors investigated by immunohistochemistry the distribution of protective protein in human tissues. Immunoreactivity was observed in the cytoplasm, revealing a granular pattern and cell type specificity. The most intense staining was observed in the large neurons of brain, distal and collecting tubular cells of kidney, epithelial cells of bronchus, and Leydig cells of testis. In a patient with galactosialidosis type IIa, all these stains were absent. The neurons that were most strongly stained in the control group, such as the Betz cells, neurons in the basal forebrain, motor neurons in the cranial nerve nuclei, and ventral horn cells of the spinal cord, were markedly ballooned in the patient with galactosialidosis.

Noise-induced regularity of spatial wave patterns in subalpine abies forests

In subalpine forests dominated by Abies species in Japan and northeastern United States, trees show traveling wave of regeneration with many striped zones of tree dieback, moving downwind at a constant rate. Previous theoretical studies have demonstrated that a very simple model can generate wave-like spatio-temporal patterns of tree regeneration in a lattice-structured habitat with each site occupied by a cohort of trees. A cohort taller than the average height of its windward neighbor experiences stand-level dieback in the next time step and the height becomes zero. Otherwise the cohort increases its height at a constant rate. Starting from a random initial pattern, this simple deterministic model can generate a saw-toothed pattern that moves downwind at a constant rate, but the distance between adjacent dieback zones has a large variance. In this paper, we study the effects of "noises" in tree dieback rules in two forms which help to generate more regular patterns: (1) additional random disturbances at a low rate, which change the size of "clusters" (defined as a group of cohorts between adjacent dieback zones) by splitting a large cluster into two or by merging a small one with a neighbor, and (2) the stochastic rule of tree dieback, represented by the probability of dieback in unit time being a sigmoidal function of the difference in the tree height between the site and the windward neighbors. These noises are effective both for one-dimensional and two-dimensional models, but spatial patterns are much more regular in the two-dimensional model than in the one-dimensional model. Copyright 1998 Academic Press

Monoclonal-based enzyme-linked immunosorbent assay and immunochromatographic rapid assay for monensin

Monensin, a member of the ionophoric polyether antibiotics, is used primarily as a coccidiostat. A protein conjugate of monensin was prepared and utilized to produce monoclonal antibodies in the BALB/c-P3X63Ag8U.1 fusion system. Only one hybridoma that produces monoclonal antibody against monensin was isolated from one in 329 wells. The monoclonal antibody was used to develop quantitative assays for monensin by means of an enzyme-linked immunosorbent assay (ELISA). The detection limit was 1 ng ml-1 and the relative standard deviations were 2.1-6.3% intra-assay and 5.9-12.9% inter-assay. All ELISA results for assay of chicken plasma and cattle milk were confirmed using a bioassay to be used as the official method. The ELISA and bioassay results showed close correlations for plasma (r2 = 0.98, n = 25) and milk (r2 = 0.95, n = 25). Using the anti-monensin monoclonal antibodies produced, a rapid test kit based on the immunochromatographic method was developed. Detection limits of monensin for cattle milk, cattle plasma and chicken plasma were about 40, 40 and 160 ppb. respectively.

Three-dimensional brain visualization for metachromatic leukodystrophy

The basic understanding of many neurogenetic diseases requires study of the clinical, biochemical, and pathological aspects. To study the pathological aspects, the organs affected by the disease must be observed. We have used volume visualization techniques to create three-dimensional (3D) brain images of a patient with late infantile metachromatic leukodystrophy (MLD). The 3D brain images showed clearly, stereographically, and non-invasively the intracerebral lesion. This lesion, which indicated hyperintensity in magnetic resonance (MR) images, extended throughout the periventricular white matter. The 3D brain images are provided to integrate information. Volumetric ray-casting was useful in obtaining directly images of the entire brain and in allowing an intuitive understanding of the extension of the lesion in three dimensions and of the extent of the defects in the MLD brain. Isosurfacing facilitated a clear extraction of the lesion located by volumetric ray-casting. Each technique used in this study played a role in visualization and their use was complementary. 3D brain images will promote morphological investigation of neurogenetic diseases.

Measles encephalomyelitis in a patient with a history of vaccination

Secondary vaccine failure (SVF) of measles is generally believed to run a milder course of illness than an ordinary course of infection. Severe complications such as central nervous system involvement have rarely been reported. A 12 year old girl, who had received a live attenuated measles vaccine 10 years earlier, developed an encephalomyelitis in the absence of symptoms indicative of ordinary measles such as Koplik spots. Anti-measles hemagglutination inhibition (HI) titer and measles IgM and IgG antibody titers were measured in a commercial laboratory. Measles virus genomic sequence was detected by polymerase chain reaction. Both serum and cerebrospinal fluid (CSF) samples obtained at acute phase already showed extremely high titers of HI (x8192 in serum and x1024 in CSF, respectively) and IgG antibody along with the presence of IgM antibody. Polymerase chain reaction detected the measles virus genomic sequence in the acute phase CSF. The patient's definite history of measles vaccination, high titers of HI and IgG antibodies observed at the very early stage of illness and the clinical course indicated that this patient has an encephalomyelitis due to SVF of measles. It is suggested that measles virus can be a pathogen of encephalitis without symptoms indicative of ordinary measles in individuals who received live attenuated measles vaccines.

Protective protein as an endogenous endothelin degradation enzyme in human tissues

An enzyme hydrolyzing the carboxyl terminus of endothelin-1 was detected in control human tissues but was deficient in tissues from a patient with galactosialidosis, a metabolic disease caused by the protective protein gene mutation. It was proportional to the amount of immunologically estimated mature protective protein. An antibody against the lysosomal protective protein/beta-galactosidase complex precipitated the enzyme activity almost completely. Transfection of the human cDNA for protective protein resulted in high expression of the enzyme activity in transformed fibroblasts from a galactosialidosis patient. These results indicated that the mature protective protein is a major soluble endogenous endothelin degradation enzyme in human tissues.

Distribution of lysosomal protective protein in human tissues

We raised two polyclonal antibodies against synthetic oligopeptides comprising amino acid sequences in the human lysosomal protective protein. The first antibody recognized the 54-kDa precursor and the N-terminal sequence of the 32-kDa mature protein subunit, and the second one recognized the precursor and the C-terminal sequence of the 20-kDa subunit. In normal fibroblasts, mature protective protein was detected on immunoblotting with these antibodies. Considerable amounts of mature protective protein also were detected in kidney, lung, liver, and spleen, but not in brain from a patient with Gaucher disease. Neither the precursor nor the mature protective protein was detected in cultured fibroblasts, liver or cerebrum from a galactosialidosis patient with protective protein deficiency.

[Patterns of mediastinal and supraclavicular metastases in apical invasive lung cancer--importance of supraclavicular lymph node dissection]

Thirty-one patients with apical invasive lung cancer, who underwent surgical therapy were analyzed. In the patients with palpable nodal metastases in the supraclavicular region, the lymph nodes were dissected through a collar incision in supine position after thoracotomy. In the patients without palpable nodes, the supraclavicular nodes were dissected through the same wound and in the same position after the tumor was resected by the hook or anterior approach. N factor was N0 in eighteen patients, N1 in two patients, N2 in seven patients, and N3 in four patients. The ratio of supraclavicular metastasis was 33.3%. Patterns of mediastinal and supraclavicular metastases were classified into three types. Type I (supraclavicular type): metastasized directly to the supraclavicular nodes via the chest wall, Type II (mediastinal type): metastasized via a common route from hilum to mediastinum, Type III (mixed type): combination of Type I and Type II. Of the nine patients who had N2 or N3 disease uncovered by supraclavicular lymph node dissection, one patient was Type I, six were Type II, and two were Type III. Of the four patients with supraclavicular node metastasis, two had palpable nodes and two histological metastasis. The nodes were metastasized via the chest wall in three patients. Two patients with N3 disease are still alive without recurrence, one patient for eighty-six months and another for twenty months after the operation. Since supraclavicular lymph nodes are local and very near from involved structures of apical invasive lung cancer, dissection of these nodes will provide improved prognosis.

[Cavernous lymphangioma of mediastinum--a case report]

A 2-year-old girl with mediastinal cavernous lymphangioma was successfully treated in 1991. She had a cough and an abnormal shadow in the right mediastinum was shown on her chest X-ray. The tumor, which spread from the right upper mediastinum to the pre-aorta, was demonstrated on CT and MRI. On August 8, 1991, the operation was performed through the right thoracotomy. The tumor was located in the right-upper and middle mediastinum and involved N. phrenics and vagus, but didn't invade and was completely resected. It was 4.2 x 3.4 x 3.2 cm in size and the cut surface of the tumor had an appearance consisting of the soft solid tissue, but containing partial cystic spaces. Histological diagnosis was cavernous lymphangioma. The mediastinal cavernous lymphangioma has been reported in only 6 cases in the Japanese medical literature.

A Japanese family of X-linked auto-immune enteropathy with haemolytic anaemia and polyendocrinopathy

Three cases of X-linked auto-immune enteropathy with haemolytic anaemia and polyendocrinopathy are described from one related Japanese kindred. Two boys had died due to severe diarrhoea accompanied by total or subtotal intestinal villous atrophy. In contrast, although one patient showed the same symptoms and had circulating IgG antibodies against enterocytes, his condition improved dramatically and he developed well following the use of cyclosporin A (CSA). CSA may be beneficial in patients with this rare disorder. Auto-immune enteropathy should be considered as a cause of protracted diarrhoea with unknown aetiology.

[Clinical and laboratory studies in seven patients with pre-B cell leukemia in children]

We have experienced and treated seven patients of pre-B cell leukemia in childhood. Clinical, cytological and ultrastructural characteristics of them were studied. Most of them had higher counts of white blood cells, hepatosplenomegaly, high value of lactic dehydrogenase and various karyotype abnormalities at onset. The chromosomal translocation t (1; 19) that is supposed to be specific to pre-B cell ALL was found in four of seven of our cases. In the seven patients, survival was studied in comparison to that of 27 common ALL patients at our hospital that are common in childhood acute leukemia. Although no difference in remission duration and survival time between pre-B cell ALL patients and common ALL group, there have been seen the tendency that remission and survival were of shorter duration for patients with pre-B cell ALL.

[Cutaneous malignant lymphoma in childhood]

Two cases of malignant lymphoma in childhood were studied. The first case was a Japanese girl aged 8, in whom the primary site was skin of the right temple. The second case was a 4-year-old Japanese boy, who had metastases to the abdominal skin. Histochemical findings indicated B-cell lineage in both cases. Primary cutaneous lymphoma is extremely rare in childhood. Fourteen such cases that have been reported in Japan and our case added to them, were reviewed. The relationship between their morphologic, immunohistochemical and clinical findings were summarized and discussed. Although the prognosis of lymphoma confined to skin in childhood has been reported not to be bad as compared with other types of lymphoma, our first such case was fatal. This suggests that appropriate initial treatment is very important. Recent advances in science may clarify the clinical and biologic characteristics of this tumor in the near future.

[A case of male breast cancer with special reference to the hormonal environment during chemoendocrine therapy]

Chemoendocrine therapy was performed on a man with advanced breast cancer, and partial response was observed for 11 months. Estrogen receptor in cancer tissue was detected before and after the therapy. Progesterone receptor, however, was not detected after the treatment, whether it had been there or not prior to it. The serum estrone level was continuously high during the treatment, but the serum testosterone level was obviously decreased after that.