Generation of chimpanzee induced pluripotent stem cell lines for cross-species comparisons

As humans' closest living relatives, chimpanzees offer valuable insights into human evolution. However, technical and ethical limitations hinder investigations into the molecular and cellular foundations that distinguish chimpanzee and human traits. Recently, induced pluripotent stem cells (iPSCs) have emerged as a novel model for functional comparative studies and provided a non-invasive alternative for studying embryonic phenomena. In this study, we generated five new chimpanzee iPSC lines from peripheral blood cells and skin fibroblasts with SeV vectors carrying four reprogramming factors (human OCT3/4, SOX2, KLF4, and L-MYC) and characterized their pluripotency and differentiation potential. We also examined the expression of a human-specific non-coding RNA, HSTR1, which is predicted to be involved in human brain development. Our results show that the chimpanzee iPSCs possess pluripotent characteristics and can differentiate into various cell lineages. Moreover, we found that HSTR1 is expressed in human iPSCs and their neural derivatives but not in chimpanzee counterparts, supporting its possible role in human-specific brain development. As iPSCs are inherently variable due to genetic and epigenetic differences in donor cells or reprogramming procedures, it is essential to expand the number of chimpanzee iPSC lines to comprehensively capture the molecular and cellular properties representative of chimpanzees. Hence, our cells provide a valuable resource for investigating the function and regulation of human-specific transcripts such as HSTR1 and for understanding human evolution more generally.

Generation and Maintenance of Primate Induced Pluripotent Stem Cells Derived from Urine

Cross-species approaches studying primate pluripotent stem cells and their derivatives are crucial to better understand the molecular and cellular mechanisms of disease, development, and evolution. To make primate induced pluripotent stem cells (iPSCs) more accessible, this paper presents a non-invasive method to generate human and non-human primate iPSCs from urine-derived cells, and their maintenance using a feeder-free culturing method. The urine can be sampled from a non-sterile environment (e.g., the cage of the animal) and treated with a broad-spectrum antibiotic cocktail during primary cell culture to reduce contamination efficiently. After propagation of the urine-derived cells, iPSCs are generated by a modified transduction method of a commercially available Sendai virus vector system. First iPSC colonies may already be visible after 5 days, and can be picked after 10 days at the earliest. Routine clump passaging with enzyme-free dissociation buffer supports pluripotency of the generated iPSCs for more than 50 passages.

Regulatory and coding sequences of TRNP1 co-evolve with brain size and cortical folding in mammals

Brain size and cortical folding have increased and decreased recurrently during mammalian evolution. Identifying genetic elements whose sequence or functional properties co-evolve with these traits can provide unique information on evolutionary and developmental mechanisms. A good candidate for such a comparative approach is TRNP1, as it controls proliferation of neural progenitors in mice and ferrets. Here, we investigate the contribution of both regulatory and coding sequences of TRNP1 to brain size and cortical folding in over 30 mammals. We find that the rate of TRNP1 protein evolution (ω) significantly correlates with brain size, slightly less with cortical folding and much less with body size. This brain correlation is stronger than for >95% of random control proteins. This co-evolution is likely affecting TRNP1 activity, as we find that TRNP1 from species with larger brains and more cortical folding induce higher proliferation rates in neural stem cells. Furthermore, we compare the activity of putative cis-regulatory elements (CREs) of TRNP1 in a massively parallel reporter assay and identify one CRE that likely co-evolves with cortical folding in Old World monkeys and apes. Our analyses indicate that coding and regulatory changes that increased TRNP1 activity were positively selected either as a cause or a consequence of increases in brain size and cortical folding. They also provide an example how phylogenetic approaches can inform biological mechanisms, especially when combined with molecular phenotypes across several species.

Evaluation of occlusal status of Japanese adults based on functional tooth units

OBJECTIVES

Although extensive national oral health data on dental caries and periodontal diseases in Japan are available, few studies have assessed the occlusal status of the Japanese population, and none are based on national survey data. The presence and prosthodontic conditions of the molar region are important for masticatory function, and the functional tooth unit (FTU) approach can be used to evaluate the occlusal status. Thus, using the national oral health survey data, this study investigated the occlusal status of the Japanese population using FTU.

METHODS

Overall, 3,605 adults (aged ≥20 years) who participated in the 2011 Japanese national oral health survey were included. FTUs were used as indices for evaluating the occlusal status. FTUs were calculated according to sex, age group, and the number of teeth present, and their associations were further analysed.

RESULTS

The number of teeth present, posterior teeth, and FTUs decreased with age in both men and women. In the age group of those ≥60 years, all only natural teeth-FTU (n-FTU) and natural teeth and artificial teeth from fixed prostheses or implant-supported FTU (nif-FTU) scores were <8. The total-FTU scores of all age groups, except the 60-69 and 70-79 years age groups, were >10.

CONCLUSION

This is the first study to use FTUs and national oral health survey data to investigate the occlusal status in the Japanese population. People aged ≥60 years who have low n-FTU or natural teeth and artificial teeth from fixed prostheses or implant-supported FTU scores or those aged 60-70 years who have the lowest total-FTU scores require careful evaluation of masticatory performance.

Derivation of induced pluripotent stem cells in Japanese macaque (Macaca fuscata)

Non-human primates are our closest relatives and are of special interest for ecological, evolutionary and biomedical research. The Japanese macaque (Macaca fuscata) has contributed to the progress of primatology and neurosciences over 60 years. Despite this importance, the molecular and cellular basis of the Japanese macaque remains unexplored since useful cellular tools are lacking. Here we generated induced pluripotent stem cells (iPSCs) from skin fibroblasts of the Japanese macaque with Sendai virus or plasmid vectors. The Japanese macaque iPSCs (jm-iPSCs) were established under feeder-free culture conditions, but feeder cells turned out to be essential for their maintenance. The jm-iPSCs formed human iPSC-like flat colonies which were positive for pluripotent antigens including alkaline phosphatase, SSEA4, and TRA-1-81. They also expressed endogenous OCT3/4, SOX2, L-MYC, and KLF4 and other pluripotent marker genes. The potential to differentiate into all three germ layers and neural stem cells was confirmed by embryoid body and neurosphere formation, respectively. The jm-iPSCs will provide a robust in vitro tool for investigating the underlying mechanisms of development and physiology studies with the Japanese macaque.

Prevalence and risk factors of halitosis in Japanese school children

BACKGROUND

Little data are available regarding halitosis in Japanese children. The aim of the current study was to investigate the prevalence and risk factors associated with halitosis in Japanese elementary and junior high school children.

METHODS

The subjects consisted of 520 elementary (1st-6th grade: boys, n = 284; girls, n = 236) and 248 junior high (7th-9th grade: boys, n = 136; girls, n = 112) school children aged 6-15 years in Saitama Prefecture, Japan. A self-administered questionnaire survey; halitosis measurement using an organoleptic assessment method; and clinical oral examination were conducted.

RESULTS

Overall, 44.9% of subjects had halitosis. The proportion of boys with halitosis was 43.6% and that of girls was 46.6%. On logistic regression analysis, grade and tongue coating were significant predictors of halitosis. The 7th-9th graders were significantly more likely to have halitosis than 1st-3rd graders (OR, 1.83; P = 0.007). Subjects with area of tongue coating score 2 or 3 were 5.51-fold more likely to present with halitosis (P < 0.001) than those with area of tongue coating score 0 or 1. Similarly, subjects with thickness of tongue coating score 2 or 3 were 3.28-fold more likely to have halitosis than those with thickness of tongue coating score 0 or 1 (P < 0.001).

CONCLUSIONS

Halitosis in the school children is not a rare condition; instead, its occurrence is relatively high. Therefore, inclusion of a halitosis prevention and management component in school oral health programs would lead to the promotion of overall oral health.

Epigenetic Variation between Human Induced Pluripotent Stem Cell Lines Is an Indicator of Differentiation Capacity

Variation in the differentiation capacity of induced pluripotent stem cells (iPSCs) to specific lineages is a significant concern for their use in clinical applications and disease modeling. To identify factors that affect differentiation capacity, we performed integration analyses between hematopoietic differentiation performance and molecular signatures such as gene expression, DNA methylation, and chromatin status, using 35 human iPSC lines and four ESC lines. Our analyses revealed that hematopoietic commitment of PSCs to hematopoietic precursors correlates with IGF2 expression level, which in turn depends on signaling-dependent chromatin accessibility at mesendodermal genes. Maturation capacity for conversion of PSC-derived hematopoietic precursors to mature blood associates with the amount and pattern of DNA methylation acquired during reprogramming. Our study therefore provides insight into the molecular features that determine the differential capacities seen among human iPSC lines and, through the predictive potential of this information, highlights a way to select optimal iPSCs for clinical applications.

Present and future challenges of induced pluripotent stem cells

Growing old is our destiny. However, the mature differentiated cells making up our body can be rejuvenated to an embryo-like fate called pluripotency which is an ability to differentiate into all cell types by enforced expression of defined transcription factors. The discovery of this induced pluripotent stem cell (iPSC) technology has opened up unprecedented opportunities in regenerative medicine, disease modelling and drug discovery. In this review, we introduce the applications and future perspectives of human iPSCs and we also show how iPSC technology has evolved along the way.

Taste hyposensitivity in Japanese schoolchildren

Background

There is some research on taste disorder/hyposensitivity in special groups such as the elderly or patients presenting with specific taste problems, however few studies have been conducted among young populations. The objectives of this study were to estimate the prevalence of taste hyposensitivity and to investigate the relationship between taste hyposensitivity and oral health status in Japanese schoolchildren.

Methods

Subjects were 237 primary and 112 junior high school students in Saitama Prefecture, Japan. In total, 349 (boys: 181, girls: 168) students aged 6–15 years participated in the study. Oral examinations and whole-mouth taste tests using four tastes (sweet, salt, sour and bitter) solutions were conducted on the subjects. A subject who could not recognize the taste of the solution was defined as demonstrating hyposensitivity.

Results

Hyposensitivity was observed in 6.3% of all subjects for sweet-taste, 14.3% for salt-taste, 20.9% for sour-taste and 6.0% for bitter-taste. The prevalence of sweet, sour and bitter-taste hyposensitivity decreased as the subjects’ grade advanced. In contrast, the prevalence of salt-taste hyposensitivity increased in 7^th-9^th grade subjects. Furthermore, the prevalence of bitter-taste hyposensitivity was significantly higher in males than females among 1^st-3^rd graders.

Taste hyposensitivity had little association with oral health status, such as decayed teeth, filled teeth, dental plaque, gingival status and tongue coating.

Conclusions

In this study, taste hyposensitivity was observed in 6.0%-20.9% of the students. There was little association between taste hyposensitivity and oral health status. The current study implies that the factors affecting the taste hyposensitivity in children may different from those in the elderly. Therefore it is necessary to further investigate the causes of taste hyposensitivity among younger generation.

Exploring taste hyposensitivity in Japanese senior high school students

AIM

The main objective of this study was to investigate the prevalence of taste hyposensitivity and the relationships between sex, oral health status, and eating habits with taste hyposensitivity in Japanese senior high school students.

METHODS

Oral examinations, sweet and salt whole-mouth taste tests, and a questionnaire about eating habits were conducted on 234 senior high school students. Factors affecting taste hyposensitivity were investigated using a multivariate analysis.

RESULTS

Sweet-taste hyposensitivity was observed in 7.3% of the students, and salt-taste hyposensitivity in 22.2%. Approximately 3% of the students had both sweet- and salt-taste hyposensitivity, and 22.6% had either sweet- or salt-taste hyposensitivity. In total, 26% had a taste hyposensitivity. There were significant relationships between the intake of instant noodles with sweet-taste hyposensitivity, and the intake of vegetables or isotonic drinks with salt-taste hyposensitivity.

CONCLUSIONS

There was a significant association between eating habits and taste hyposensitivity in Japanese senior high school students. Taste tests would be a helpful adjunct for students to recognize variations in taste sensitivity, and a questionnaire about their eating habits might provide an effective self-review of their eating habits, and therefore, provide motivation to change.

Oral malodor and related factors in Japanese senior high school students

BACKGROUND

Oral malodor (halitosis or bad breath) might be an important motivation tool for improving oral health in adolescents. There are few studies that report the epidemiology of oral malodor in high school students and the relationships with lifestyle and oral health status. This research was conducted to obtain underlying data for introducing an oral health education program which targeted prevention of oral malodor as a motivation tool for changing oral health behavior in high school students.

METHODS

A questionnaire, school oral examination, and oral malodor measurement were conducted on senior high school students in a Tokyo metropolitan school in 2007. A total of 474 students (male: 219, female: 255) were used for the analysis.

RESULTS

Over 42% of subjects reported that they had experienced anxiety, or were conscious of oral malodor, on at least 1 occasion. The students who had detectable oral malodor comprised 39.6% of subjects. The binary logistic regression analyses showed that whether or not subjects ate breakfast before the oral examination (p < .05), the presence of plaque (p < .01), and presence of a substantive tongue coating (p < .01) were related to the presence of detectable oral malodor.

CONCLUSIONS

Cleaning the oral cavity and eating breakfast are important to prevent oral malodor in high school students. This study indicated that school health education incorporating prevention of oral malodor as a motivation tool for oral health promotion could be a valuable procedure to include in high school dental health education programs.

Effects of a mouthwash with chlorine dioxide on oral malodor and salivary bacteria: a randomized placebo-controlled 7-day trial

Background

Previous research has shown the oxidizing properties and microbiological efficacies of chlorine dioxide (ClO₂). Its clinical efficacies on oral malodor have been evaluated and reported only in short duration trials, moreover, no clinical studies have investigated its microbiological efficacies on periodontal and malodorous bacteria. Thus, the aim of this study was to assess the inhibitory effects of a mouthwash containing ClO₂ used for 7 days on morning oral malodor and on salivary periodontal and malodorous bacteria.

Methods/Design

A randomized, double blind, crossover, placebo-controlled trial was conducted among 15 healthy male volunteers, who were divided into 2 groups. Subjects were instructed to rinse with the experimental mouthwash containing ClO₂ or the placebo mouthwash, without ClO₂, twice per day for 7 days. After a one week washout period, each group then used the opposite mouthwash for 7 days. At baseline and after 7 days, oral malodor was evaluated with Organoleptic measurement (OM), and analyzed the concentrations of hydrogen sulfide (H₂S), methyl mercaptan (CH₃SH) and dimethyl sulfide ((CH₃)₂S), the main VSCs of human oral malodor, were assessed by gas chromatography (GC). Clinical outcome variables included plaque and gingival indices, and tongue coating index. The samples of saliva were microbiologically investigated. Quantitative and qualitative analyses were performed using the polymerase chain reaction-Invader method.

Results and Discussion

The baseline oral condition in healthy subjects in the 2 groups did not differ significantly. After rinsing with the mouthwash containing ClO₂ for 7 days, morning bad breath decreased as measured by the OM and reduced the concentrations of H₂S, CH₃SH and (CH₃)₂S measured by GC, were found. Moreover ClO₂ mouthwash used over a 7-day period appeared effective in reducing plaque, tongue coating accumulation and the counts of Fusobacterium nucleatum in saliva. Future research is needed to examine long-term effects, as well as effects on periodontal diseases and plaque accumulation in a well-defined sample of halitosis patients and broader population samples.

Trial registration

ClinicalTrials.gov NCT00748943

[Thoracic aortic aneurysm associated with pseudocoarctation; report of a case]

A 20-year-old woman without any significant history of disease was referred for further investigation of an aortic arch aneurysm. The arterial blood pressure in the right arm was higher than in the left arm and in both legs. An multi-detector row computed tomography (MDCT) and an aortogram revealed narrowing of the middle aortic arch, kinking at the ligamentum arteriosum, subsequent multiple aneurysmal formation, and stenosis and narrowing of the descending aorta. The left subclavian artery branched from the 1st aneurysm. We resected the aneurysms and reconstructed the distal aortic arch and left subclavian artery using a woven polyester graft. This case was diagnosed as thoracic aortic aneurysm associated with pseudocoarctation, which is a quite rare congenital anomaly.

Size effects of nanomaterials on lung inflammation and coagulatory disturbance

Effects of nano-sized materials (nanomaterials) on subjects with predisposing inflammatory disorders have not been well elucidated. This study examined the effects of pulmonary exposure to TiO2 nanomaterials on lung inflammation induced by lipopolysaccharide (LPS) and consequent systemic inflammation with coagulatory disturbance in mice, in particular regarding their size-dependency. Also, gene expression pattern in the lung was compared among the experimental groups using cDNA microarray analysis. ICR male mice were divided into 8 experimental groups that intratracheally received vehicle, three sizes (15, 50, 100 nm) of TiO2 nanomaterials (8 mg/kg), LPS (2.5 mg/kg), or LPS plus nanomaterials. Twenty four h after the treatment, these nanomaterials exacerbated the lung inflammation and vascular permeability elicited by LPS, with an overall trend of amplified lung expressions of cytokines such as interleukin (IL)-1beta, macrophage chemoattractant protein (MCP)-1, and keratinocyte chemoattractant (KC). LPS plus nanomaterials, especially of a size less than 50 nm, elevated circulatory levels of fibrinogen, IL-1beta, MCP-1, and KC, and von Willebrand factor as compared with LPS alone. The enhancement tended overall to be greater with the smaller nanomaterials than with the larger ones. cDNA microarray analyses revealed that there was no difference in gene expression pattern between the LPS group and the LPS + nanomaterial. These results suggest that nanomaterials exacerbate lung inflammation related to LPS with systemic inflammation and coagulatory disturbance, and that the exacerbation is more prominent with smaller nanomaterials than with larger ones.

65 NUCLEAR REPROGRAMMING OF PORCINE CELLS AND THEIR USE AS DONOR CELL FOR NUCLEAR TRANSFER AFTER TREATMENT IN XENOPUS EGG EXTRACTS

Revealing an adequate cell state for nuclear reprogramming is essential to achieve efficient production of cloned embryos and animals. Previous reports suggest that nuclei from undifferentiated cells such as blastomeres or embryonic stem cells can support efficient development of cloned embryos to term. In recent years, differentiated somatic cells are frequently used for donor cells because of ease of preparation and application for genetic modification. The efficiency of the somatic cell nuclear transfer (SCNT) is still extremely low. We hypothesized that somatic cells that had been reprogrammed to dedifferentiated states before SCNT might support higher developmental ability of SCNT embryos. To test this hypothesis, porcine fibroblast cells were treated with Xenopus egg extracts, and the extract-treated cells (ETCs) were used as donor cell for SCNT to examine their ability to support early embryonic development. Xenopus egg extracts were prepared from activated S-phase eggs. Porcine fibroblast cells (106/mL) were permeabilized by 500 ng mL-1 of Streptolysin O and were incubated in the egg extracts with the energy-regenerating system for 2 hours at 23�C. After the extract treatment, permeabilized membranes were resealed in DMEM containing 2 mM CaCl2. The ETCs were fused with porcine enucleated oocytes and simultaneously activated. The reconstructed embryos were cultured in PZM-3 medium for 7 days. All statistical differences were analyzed by ANOVA. Reprogramming of ETCs was evaluated on changes of chromatin states and gene expression. Chromatin-binding proteins of ETCs were separated and analyzed on SDS-PAGE. Some proteins were incorporated onto and/or released from chromatins after the extract treatment. Especially, Xenopus egg-specific linker histone B4 was assembled on chromatins. Non-permeabilized control cells did not show these protein exchanges. Deacetylation of histone H3 lysine9 was detected in half number of ETCs in an ATP-dependent manner. In contrast, a high population of histone H3-acetylated cells was observed in buffer-treated cells as well as cells before the extract treatment. The pluripotent marker gene expression, such as OCT4 and SOX2, was also observed in ETCs after culture. The gene expression of these genes was not detected in non-treated cells. These results indicate that the extract treatment induces or triggers a part of dedifferentiation of somatic cells. These ETCs were used as donor cell for SCNT, and reconstructed cloned embryos were cultured. SCNT embryos showed no significant difference in cleavage rates and developmental rates to the blastocyst stage (25%) compared with non-treated control cells (26%). However, the total cell number of embryos at the blastocyst stage was significantly higher in SCNT embryos from ETCs compared with those of control cells (62 � 7 vs. 43 � 2, respectively; P &lt; 0.05). These results indicate that the extract treatment before nuclear transfer may stimulate cell proliferation of SCNT embryos but not improve early development. More studies, however, are needed to investigate their developmental ability to term.

Reprogramming events of mammalian somatic cells induced byXenopus laevis egg extracts

It is known that differentiated cells can be reprogrammed to an undifferentiated state in oocyte cytoplasm after nuclear transfer. Recently, some reports suggested that Xenopus egg extracts have the ability to reprogram mammalian somatic cells. Reprogramming events of mammalian cells after Xenopus egg extract treatment and after cell culture of extract-treated cells have not been elucidated. In this experiment, we examined reprogramming events in reversibly permeabilized or nonpermeabilized porcine fibroblast cells after Xenopus egg extract treatment. The Xenopus egg-specific histone B4 was assembled on porcine chromatin and nuclear lamin LIII was incorporated into nuclei. Deacetylation of histone H3 at lysine 9 in extract-treated cells was detected in nonpermeabilized cells, suggesting that a part of reprogramming may be induced even in nonpermeabilized cells. Following culture of extract-treated cells, the cells began to express the pluripotent marker genes such as POU5F1 (OCT4) and SOX2 and to form colonies. Reactivation of the OCT4 gene in extract-treated cells was also confirmed in bovine fibroblasts transformed with an OCT4-EGFP construct. These results suggest that nuclei of mammalian cells can be partially reprogrammed to an embryonic state by Xenopus egg extracts and the remodeled cells partly dedifferentiate after cell culture. A system using egg extracts may be useful for understanding the mechanisms and processes of dedifferentiation and reprogramming of mammalian somatic cells after nuclear transfer.

A defect in protein farnesylation suppresses a loss of Schizosaccharomyces pombe tsc2+, a homolog of the human gene predisposing to tuberous sclerosis complex

Mutations in the human Tsc1 and Tsc2 genes predispose to tuberous sclerosis complex (TSC), a disorder characterized by the wide spread of benign tumors. Tsc1 and Tsc2 proteins form a complex and serve as a GTPase-activating protein (GAP) for Rheb, a GTPase regulating a downstream kinase, mTOR. The genome of Schizosaccharomyces pombe contains tsc1(+) and tsc2(+), homologs of human Tsc1 and Tsc2, respectively. In this study we analyzed the gene expression profile on a genomewide scale and found that deletion of either tsc1(+) or tsc2(+) affects gene induction upon nitrogen starvation. Three hours after nitrogen depletion genes encoding permeases and genes required for meiosis are less induced. Under the same condition, retrotransposons, G1-cyclin (pas1(+)), and inv1(+) are more induced. We also demonstrate that a mutation (cpp1-1) in a gene encoding a beta-subunit of a farnesyltransferase can suppress most of the phenotypes associated with deletion of tsc1(+) or tsc2(+). When a mutant of rhb1(+) (homolog of human Rheb), which bypasses the requirement of protein farnesylation, was expressed, the cpp1-1 mutation could no longer suppress, indicating that deficient farnesylation of Rhb1 contributes to the suppression. On the basis of these results, we discuss TSC pathology and possible improvement in chemotherapy for TSC.

[A case of extracardiac unruptured aneurysm of sinus of Valsalva with obstruction of the right coronary artery and aortic regurgitation]

A 67-year-old female was admitted to our hospital with heart failure. Echocardiography, chest CT and MRA revealed an unruptured aneurysm of sinus of Valsalva. Cardiac catheterization and angiography detected obstruction of the ostium of the right coronary artery and moderate aortic regurgitation. Operative findings showed an extracardiac unruptured aneurysm arising from the right sinus of Valsalva. The orifice of the aneurysm was closed with Gore-Tex patch, then aortic valve replacement combined with single CABG to RCA was simultaneously performed. The pathological findings strongly suggested its acquired origin.

A case of intravascular large B-cell lymphoma mimicking erythema nodosum: the importance of multiple skin biopsies

BACKGROUND

Intravascular lymphoma is a rare disease characterized by the proliferation of neoplastic monuclear cells within the lumens of small blood vessels. The neoplastic cells are usually of B-cell origin, and rarely of T-cell or histiocytic origin. Although this clinicopathological entity of lymphoma has not been listed in general pathological classifications such as REAL classification or the Working Formulation, it is recently in the WHO classification scheme, which is essentially an updated REAL scheme, and the EORTC classification scheme.

METHODS

In this report, a 62-year-old woman with intravascular large B-cell lymphoma was observed by clinical, histopathological, immunohistochemical and molecular methods.

RESULTS

A 62-year-old woman presented with large erythematous macules on the bilateral thighs and lower legs. The lesions were accompanied with hard, tender, intradermal or subcutaneous nodules mimicking erythema nodosum. Histopathological examination in the first biopsy revealed non-specific panniculitis compatible with erythema nodosum. The second biopsy revealed emboli of atypical lymphocytes within many of the dilated and proliferated vessels in the deep dermis and subcutaneous tissue. These cells were positive for L-26 and kappa light chain, and negative for lambda light chain, factor VIII-related antigen, CD30, CD34, CD68 and UCHL-1. These findings confirmed the diagnosis of intravascular large B-cell lymphoma. A laboratory examination showed a high level of LDH and abnormal cells in the bone marrow. An MRI of the brain and computed tomographic (CT) scans of the chest and abdomen revealed no evidence of malignancy. Before the treatment, the size of the nodules decreased spontaneously by about 50% in one month and significantly in two months. Although combination chemotherapy, which consisted of CHOP, brought her partial remission, she experienced neurological symptoms 6 months after the initial treatment and died of brain metastasis 9 months after the treatment.

CONCLUSIONS

This is a unique case for two following reasons: 1) the first biopsy revealed non-specific findings compatible with erythema nodosum; and 2) before the treatment, the nodules regressed spontaneously. Dermatologists should take multiple skin biopsies for EN lesions with the non-specific histopathological findings not to refute the existence of this disease.

[Effectiveness of retrograde tepid blood cardioplegia in valve surgery combined with coronary artery bypass grafting]

The purpose of this study was to evaluate the usefulness of continuous retrograde continuous tepid blood cardioplegia (CTBC) in 8 patients underwent multivalve surgery combined with coronary artery bypass grafting (CABG) (Group 1), in comparison with antegrade CTBC in 10 patients with single valve replacement (Group 2). Aortic crossclamp time in Group 1 (187.9 +/- 55.2 minutes) was significantly longer than that (94.1 +/- 27.4) in Group 2 (p < 0.005). There was no hospital death in both groups. Spontaneous recovery rate of the heart beat following aortic declamping was 75% in Group 1, 90% in Group 2 (ns). Postoperative max CK-MB was 87.9 +/- 43.1 IU/l in Group 1, 74.8 +/- 27.0 IU/l in Group 2 (ns). During the early postoperative period, LVSWI significantly increased in both groups, whereas RVSWI showed no significant increase in both groups. Accordingly, in Group 1 in spite of longer aortic crossclamp time comparing Group 2, myocardial protection was considered to be satisfactory. In conclusion, retrograde CTBC is useful as an intraoperative myocardial protection in multivalve surgery combined with CABG which must need much longer aortic cross clamp time.

[Emergency coronary artery bypass grafting for left main coronary artery disease]

Emergency coronary artery bypass grafting (CABG) for acute coronary syndrome due to left main coronary artery (LMCA) disease still remains to be a therapeutic challenge. Seventy consecutive patients underwent CABG for LMCA disease were divided into two groups, that is 21 patients with emergency CABG (Group E) and 49 with scheduled CABG (Group S). There were four in-hospital deaths (mortality rate: 19.1%) in Group E and two (4.1%) in Group S. Three of 4 deaths in Group E had cardiogenic shock associated with acute myocardial infarction (AMI) preoperatively, and low output syndrome followed by multiple organ failure postoperatively. All of four deaths cases received intermittent cold GIK cardioplegia as an intraoperative myocardial protection. On the other hand, seven cases, received retrograde continuous warm blood cardioplegia (CWBC), including AMI with shock due to LMCA occlusion and concomitant CABG and valve replacement complicated with aortic regurgitation, all survived operations. In conclusion, retrograde CWBC may be useful as an intraoperative myocardial protection in emergency CABG for AMI with shock due to LMCA occlusion.

Effectiveness of continuous warm blood cardioplegia in cardiac valve re-replacement

BACKGROUND AND AIM OF THE STUDY

In order to achieve better operative results, myocardial protection for cardiac valve re-replacement must be further improved. The aim of this study was to compare the efficacy of continuous warm blood cardioplegia (CWBC) with that of intermittent cold potassium cardioplegia (ICPC) in cardiac valve re-replacement.

METHODS

A total of 49 consecutive patients underwent elective cardiac valve re-replacement via sternal re-entry; 27 patients received CWBC and 22 ICPC. During surgery, a narrower dissection of the heart was used in the CWBC group. The myocardial protective effects and operative outcome were analyzed in the two groups.

RESULTS

Two ICPC patients died in hospital, one from cerebral bleeding and one from low output syndrome. The rate of spontaneous recovery of the heart-beat after aortic declamping was significantly higher in CWBC patients than in the ICPC group (92.3% versus 13.6%, p < 0.001). Postoperatively, maximum serum creatine kinase-MB levels were significantly lower in CWBC patients than in ICPC patients (25.5 +/- 6.0 versus 81.1 +/- 26.0 IU/l, p < 0.02). Left ventricular stroke work index in the CWBC group showed significantly better recovery in the early postoperative period compared with that in the ICPC group. Extraction of myocardial oxygen (range: 0.33 to 0.35) and lactate (range: -0.02 to 0.14) in CWBC patients was maintained within the normal range immediately after aortic declamping and in the early postoperative period. In contrast, in ICPC patients extraction of myocardial oxygen (range: 0.18 to 0.23) and lactate (range: -0.27 to -0.17) was impaired during the same period. Postoperative (24-h) blood loss was significantly less in CWBC patients than in ICPC patients (p < 0.02).

CONCLUSION

In cardiac valve re-replacement surgery through sternal re-entry, and without wide exposure of the heart, continuous warm blood cardioplegia provides much greater myocardial protection than does intermittent cold potassium cardioplegia.

[Polymyalgia rheumatica and myelitis associated with anti-cardiolipin antibody]

A 78-year-old woman was admitted to our hospital on September 14, 1992, because of systemic myalgia and stiffness, joint pain, and gait disturbance. She had begun to feel headache and pain in the neck and shoulder in the middle of August, 1992. The pain became systemic, and was accompanied by a low-grade fever, which was unresponsive to NSAIDs. On admission, she had no joint swelling or deformities in the extremities. Neurological examination revealed weakness in the right leg, hypoalgesia below the left C4 level, hyperreflexia in the right extremities, and right Babinski's sign. The erythrocyte sedimentation rate was very high (100 mm/h). Levels of other acute phase reactants were also high. Tests for antinuclear antibody and anti-cardiolipin antibody were positive, but a test for rheumatoid factor was negative. Creatine kinase activity was within normal limits. A T1-weighted magnetic resonance image of the cervical spine at 0.5 T showed an intramedullary low signal. A T2-weighted image showed a borderless spindle-like high signal. Four nodules enhanced by Gd DTPA were seen at C1-C4. The age at onset, myalgia, stiffness, and erythrocyte sedimentation rate were considered to be consistent with a diagnosis of polymyalgia rheumatica. Glucocorticoid treatment was therefore started, and a dramatic clinical improvement was evident within a few days. The patient was discharged from hospital on November 30, 1992. To our knowledge, myelopathy complicated by polymyalgia rheumatica has never been reported previously. Recently, some patients with polymyalgia rheumatica have been reported to have anti-cardiolipin antibody in serum. In the present case anti-cardiolipin antibody may have played a role in the formation of microemboli or in angitis of the cervical spine.

[Emergency coronary artery bypass grafting in elderly patients]

Emergency coronary artery bypass grafting (CABG) in elderly patients still remains to be a therapeutic challenge for cardiac surgeons. The purpose of this study was to review the operative results of our emergency CABG in elderly patients and evaluate it's problems comparing with younger patients. Consecutive forty-three patients underwent emergency CABG for the past ten years were divided into two groups, that is 13 patients aged 75 years or older (group 1) and 30 younger than 75 years old (group 2). There were three in-hospital deaths (mortality rate: 23.1%) in group 1 and three (10.0%) in group 2. The lowest postoperative Ccr (19.1 +/- 8.9 ml/ min) in group 1 was significantly lower (p < 0.02) than that (35.6 +/- 14.4 ml/min) in group 2. Respiratory Index on the first postoperative day, which indicates lung dysfunction when it comes up to 2.0 or more, showed 2.65 in mean value in group 1 compared with 1.31 in group 2 (p < 0.05). Severe infections like sepsis were developed in 4 patients (30.8%) in group 1 and 2 (6.7%) in group 2 (p < 0.05). In conclusion, it was clearly suggested that kidney protection by earlier myocardial revascularization, prevention of severe infection and earlier introduction of respiratory physiotherapy in the postoperative period were advisable to improve the operative results of emergency CABG in elderly patients.

[A case report of subacute panencephalitis associated with specific T cells sensitized to proteolipid protein (PLP) synthetic peptides identified with rubella virus]

A 37-year-old woman was admitted to the hospital on October 4, 1991 because of fever, headache, and abnormal behavior. Although she was treated with aciclovir, she developed encephalitis, which slowly manifested itself over the next month as meningeal irritation, loss of consciousness, partial seizure, and quadriparesis. Her cerebrospinal fluid showed mild lymphocytic pleocytosis without protein elevation. Serum IgG antibody titer to rubella virus was elevated, but the rubella virus could not be detected in the cerebrospinal fluid by PCR amplification. Her consciousness level improved slowly, and by the end of November she suffered only dystonic posture of her right arm and hand. By the middle of December, there were no abnormal neurological findings except some extrapyramidal tract signs and symptoms, such as tremor and rigidity. The serum rubella virus IgG titer had fallen back into the normal range. Her illness was diagnosed as subacute panencephalitis, and she recovered completely about 5 months after the onset of the disease. The lack of rubella virus in the cerebrospinal fluid suggests that panencephalitis may not be dependent on virus replication within the central nervous system. Specific T cells sensitized to proteolipid protein synthetic peptides (PLP158-166) identified with rubella virus were detected in this case during the active stage. These observations imply that subacute panencephalitis may be dependent on an immune-mediated mechanism and that PLP-specific T cells may play an important role in pathogenesis of the disease.

[A case of amoebiasis as a latent infection]

A 69-year-old male was admitted because of constipation and abdominal distension. A colon fiberscopic examination revealed the formation of ulceration. The trophozite of Entamoeba histolytica was detected from from the specimens of colon mucosal biopsy of the ulcer. The stool was positive for the cysts of E. histolytica too. He had been in China and Southeast Asia during World War II. He returned home and experienced amoebic dysentry, and was treated with Emethin hydrochlolide. He suffered from amoebic disentry in 1970 and was treated with Emethine hydrochrolide again. After the War he had not gone abroad, and was not a homosexual. So this case was considered a latent infection of E. histolytica from the War. This time he was treated with metronidazol and minocycline. After the therapy, cysts were negative in the stool and the ulcer was cured on the colon fiberscopic examination.

[Experiences of reoperative coronary artery bypass grafting by left thoracotomy without aortic clamping]

We reported two cases which had reoperative coronary artery bypass grafting (CABG) through the left thoracotomy approach without aortic clamping with good results. Case 1. A 50-year-old man, who underwent a double CABG to left anterior descending coronary artery (LAD) and right coronary artery (RCA) in 1983, had a recurrent unstable angina due to new significant stenosis of the diagonal branch (DG) and obtuse marginal branch (OM) in 1989. He was reoperated upon, having a new double CABG to DG and OM through the left thoracotomy using hypothermic ventricular fibrillation without aortic clamping for the myocardial protection without any blood transfusion. Case 2. A 61-year-old man, who underwent a double CABG to LAD and RCA in 1982, had a recurrent unstable angina and a left ventricular aneurysm in 1991. He had a reoperation of a single CABG to OM combined with left ventricular aneurysmectomy by the same approach. Both cases showed satisfactory recoveries of the left ventricular function in the early postoperative period and patent grafts on postoperative angiograms. The left thoracotomy approach is a preferable alternative to median resternotomy for the reoperative CABG to OM, DG and left ventricular aneurysmectomy.

[Myocardial protection during aortic valve replacement: effectiveness of continuous warm blood cardioplegia]

Effectiveness of continuous warm blood cardioplegia (CWBC) during aortic valve replacement (AVR) was studied by comparing with intermittent cold GIK cardioplegia (ICGC) in 32 patients who underwent AVR using CWBC in 16 and ICGC in the other 16 patients. There was no operative nor hospital death in this series. In CWBC group, spontaneous recovery of the heart beat following aortic declamping was seen in 14 of 16 patients (87.5%), in contrast only in 4 of 16 (25%) in ICGC group. During the early postoperative period, left ventricular stroke work index (g.m/beat/m2) significantly increased from 41.0 +/- 14.4 to 55.9 +/- 8.0 (p < 0.001) in CWBC group, whereas no significant increase was found in ICGC group. Right ventricular stroke work index significantly increased only in CWBC group as well. In CWBC group, myocardial oxygen and lactate extraction rates were maintained within normal range during aortic cross-clamping, suggesting satisfactory myocardial preservation with an aerobic metabolism. In conclusion, CWBC is superior to ICGC as a myocardial protection during AVR.

[Repeat open heart surgery using continuous warm blood cardioplegia]

Myocardial protection during repeat open heart surgery still remains to be further improved. The purpose of this study was to evaluate the usefulness of continuous warm blood cardioplegia (CWBC) comparing with intermittent cold GIK cardioplegia (ICGC) in repeat open heart surgery. Twenty-four patients underwent repeat open heart surgery through re-sternotomy (11 mitral, 6 aortic 5 double, 2 congenital) were divided into two groups, that is 10 received CWBC (warm group) and 14 ICGC (Cold group). Spontaneous recovery of heart beat was obtained in 9 of 10 patients (90.0%) in warm group, in contrast only 2 of 14 (14.3%) in cold group (p < 0.001) following aortic declamping. Postoperative peak level of serum CK-MB in warm group (25.9 +/- 7.4 IU/l) was significantly lower than that (83.1 +/- 24.6) in cold group. In warm group left and right ventricular stroke work index significantly increased at 24 hours postoperatively, whereas no significant increase was found in cold group. Postoperative bleeding in the first 24 hours was less (553.8 +/- 38.9 ml) in warm group than that (974.3 +/- 54.1 ml) in cold group. In warm group 3 patients were operated on without homologous blood transfusion, in contrast none in cold group. Our results clearly demonstrated that CWBC was preferable to ICGC for myocardial protection in repeat open heart surgery.

Mechanism of changes of the collagen matrix of reperfused myocardium in donor heart preservation

Isolated canine hearts were preserved for 6 hours at 5 degrees C followed by normothermic reperfusion for 2 hours. Dogs were divided into two groups: group I (group Ia [n = 7] and group Ib [n = 3] with the left ventricle unloaded during reperfusion) received a preservation solution containing potassium (20 mmol/L), and group II (n = 9) received University of Wisconsin solution. Left ventricular diastolic function was better preserved in group II. Degradation and loss of the collagen network during reperfusion, as assessed by scanning electron microscopy, were more extensive and significantly more frequent in group Ia than in group II (6/7 versus 2/9; p < 0.05). Furthermore, extensive disruption of the collagen network was significantly more prevalent in hearts with a left ventricular end-diastolic pressure of more than 20 mm Hg than in hearts with a left ventricular end-diastolic pressure of less than 20 mm Hg (8/10 versus 0/6; p < 0.05), and no disruption of the collagen network occurred in group Ib, regardless of the type of preservation solution. These results suggest that the greatest disruption is caused by barotrauma resulting from an elevated left ventricular end-diastolic pressure after ventricular dysfunction caused by ischemic reperfusion injury.

[From Bentall's operation to its modification by Suzuki: improved technique for replacement of both aortic valve and ascending aorta]

To improve the result of surgery for replacement of both aortic valve and ascending aorta, we developed a new technique which is characterized as follows. 1) The composite graft is made during surgery according to the operative findings with tilting disc valve and very low porosity woven Dacron graft. 2) Proximal anastomosis is reinforced by double fixation method. 3) Coronary arteries are reimplanted directly into the graft as a Carrel patch. Thirty-four patients underwent this surgery with no operative death. One died in the hospital and 4 died in the late stage unrelated to the surgical technique. We recommend this method as a new standard technique for replacement of both aortic valve and ascending aorta.

[Clinical study on the prognosis of complete denture wearers covering 10 years. 4. Masticatory efficiency]

The purpose of this study was to estimate masticatory efficiency of complete denture wearers. The subjects were 72 patients, treated before 5-10 years at students' clinic of Tsurumi University, School of Dental Medicine. The masticatory efficiencies with peanuts and Kamaboko were calculated. Results 1. The mean masticatory efficiency with peanuts for 63 patients was 35.8%, and with Kamaboko (steamed fishpast) for 64 patients was 94.5%, in comparison with natural dentition. 2. The mean masticatory efficiency with peanuts was 124.3%, and with Kamaboko was 99.6%, for complete denture wearers. 3. Comparing the measured value of masticatory efficiency with 5 to 10 years wearing period, there was significant difference in the masticatory efficiency between peanuts and Kamaboko. 4. There was significant difference in the masticatory efficiency with peanuts between the group needed new denture and the group not needed but there was not significant difference with Kamaboko.

[Adrenomedullary epinephrine excretion and myocardial norepinephrine release during cardiopulmonary bypass]

It has long been known that shock or surgical stress promotes an epinephrine (E) excretion from the adrenomedullary glands. In fourteen adult cardiac patients, plasma E values in both superior vena cava (SVC) cannula and inferior vena cava (IVC) cannula during total cardiopulmonary bypass (CPB) are studied at three stages, before aortic cross clamp (pre AXC), after release of aortic cross clamp (post AXC) and at 34 degrees C rectal temperature in rewarming (34 degrees C RT). Although E values in both SVC and IVC are slightly higher values than normal in pre AXC, they increase sharply to peaked values at post AXC and decline uniformly close to normal at 34 degrees C RT. IVC-E is constantly significantly higher (statistically) than SVC-E at each of all three stages. It is strongly suggested that E response to CPB is mainly originated from the adrenomedullary glands, and cardiac reflex which has sympathetic efferent limbs triggered by myocardial ischemia can indicate the increase in E during AXC. Myocardial norepinephrine (NE) release in heart ischemia such as acute myocardial infarction has been generally accepted. To examine whether myocardial NE release occurs during AXC, if there is the association of NE release with any clinical parameters, the second investigation is done in twenty-six adult cardiac patients. Plasma NE values in both the radial artery (A) and the coronary sinus (CS) are measured at six stages, pre AXC (stage 1), post AXC (stage 2), post CPB (stage 3), three hours after off CPB (stage 4), six hours off CPB (stage 5) and twelve hours off CPB (stage 6).(ABSTRACT TRUNCATED AT 250 WORDS)