Development of Neonatal Airway Management Simulator for Evaluation of Tracheal Intubation

The long-term goal of this study is a training system that can simulate medical cases and advise physicians based on quantitative evaluation of neonatal resuscitation. In this paper, we designed and manufactured a neonatal airway management simulator for quantitative evaluation of tracheal intubation. This robotic simulator is equipped with 25 sensors of 6 types, which detect motions that lead to complications, inside the manikin replicated a neonate. A performance experiment of the developed sensor and an evaluation experiment with physicians were conducted. We observed that an erroneous operation in the laryngoscopy can be detected by the sensors in our simulator.

Associations between sleep habits and interference of premenstrual symptoms in athletic performance in Japanese adolescent athletes: a cohort study over a 2-year period

Premenstrual symptoms are common problems among female high-school and college athletes. This prospective study investigated associations between sleep habits and interference of premenstrual symptoms in athletic performance among Japanese adolescent athletes. A school-based survey on menstruation and school life was conducted among 623 female high-school students in 2015 and 2016, and data from the two surveys were connected. In total, 262 students completed the questionnaire in both years. We recruited 108 of those students who were athletes with regular menstrual cycles. Participants completed a questionnaire about their premenstrual symptoms and lifestyle habits. The prevalence of short sleep duration (<8 h) was high (95.4%). The difference in premenstrual symptom severity in individual students between the first and second years was not significant (p > .05). Premenstrual symptoms were less associated with disturbance in 'athletic performance in training or competition' in the second year than the first. 'Longer sleeping time' in the first year was associated with lower risk of increased interference of premenstrual symptoms in athletic performance in the second year (odds ratio 0.982, 95% confidence interval: 0.970-0.994). Shorter sleep duration may therefore have an effect on premenstrual symptoms' interference with athletic performance among Japanese adolescents.

Lifestyle Factors Associated with Premenstrual Syndrome: A Cross-sectional Study of Japanese High School Students

STUDY OBJECTIVE

To investigate the relationships between premenstrual syndrome (PMS) and lifestyle, sleep, and dietary habits among Japanese high school students.

DESIGN

Cross-sectional study.

SETTING

Two public high schools in Sendai, the largest city in northeastern Japan.

PARTICIPANTS

A school-based survey was conducted among 1818 female Japanese high school students in 2015, and 1022 students with regular menstrual cycles (25-38 days) completed the questionnaire.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Relationships between PMS and lifestyle, sleep, and dietary habits.

RESULTS

The rates of moderate to severe PMS and premenstrual dysphoric disorder were 9.7% (99/1022) and 2.2% (22/1022), respectively. A total of 121 students (11.9%) were classified as having PMS-the PMS(+) group. Significant differences were observed between the PMS(+) group and those without PMS-the PMS(-) group-in age at menarche (P = .022), menstrual pain (P < .001), hypnagogic disorder (P < .001), long Internet use time (P < .001), eating breakfast (P = .018), chewing well (P = .037), and belonging to a sports club (P = .046). Multivariate analysis revealed that the risk factors for PMS were menstrual pain (odds ratio [OR], 4.74; 95% confidence interval [CI]: 2.83-7.95), hypnagogic disorder (OR, 2.22; 95% CI, 1.47-3.35), stress fracture (OR, 2.19; 95% CI, 1.21-3.98), and Internet use time (OR, 1.003; 95% CI, 1.001-1.005). Belonging to a sports club decreased the risk of PMS (OR, 0.57; 95% CI, 0.35-0.91).

CONCLUSION

Sleep, dietary habits, belonging to a sports club, and screen time affect PMS among high school students.

Effectiveness of natural S-equol supplement for premenstrual symptoms: protocol of a randomised, double-blind, placebo-controlled trial

INTRODUCTION

Premenstrual syndrome (PMS) comprises a range of mood, behavioural and physical symptoms, and impairs many women's quality of life. Isoflavones are expected to stabilise the natural fluctuation of the oestrogen cycle through their selective oestrogen receptor modulator-like activities that alleviate PMS symptoms. Equol, a metabolite of a soy isoflavone converted from daidzein by specific gut bacteria, has a greater bioavailability compared with other soy isoflavones. We aim to examine the effect of natural S-equol supplements on premenstrual symptoms.

METHODS AND ANALYSIS

This study will enrol 124 women (aged 20-45 years) who have PMS symptoms and are non-equol producers in a double-blind, parallel, randomised, placebo-controlled trial, in which they will receive natural S-equol supplement (equol 10 mg a day) or placebo, orally, twice daily, for three menstrual cycles. The primary outcome measure (Daily Record of Severity of Problems total score) will be assessed during intervention cycles. To compare the primary outcomes between the S-equol group and the placebo group, the mean differences in the Daily Record of Severity of Problems total score between the two groups will be determined. The p values will be determined using Student's t-test, where the significance level is 5% (two-sided).

ETHICS AND DISSEMINATION

The institutional review board at Kindai University approved the study. The findings of this trial will be submitted to an international peer-reviewed journal. Abstracts will be submitted to national and international conferences.

TRIAL REGISTRATION NUMBER

UMIN000031815.

Effect of an educational program on adolescent premenstrual syndrome: lessons from the Great East Japan Earthquake

Background

Catastrophic disasters such as great earthquakes cause tremendous physical and mental damage. We previously reported that the Great East Japan Earthquake worsened premenstrual symptoms among adolescent girls in the disaster-stricken area.

Objectives

We reanalyzed these data to determine the positive effects of education on premenstrual symptoms.

Materials and methods

Annual school-based surveys about premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) have been conducted in Sendai since 2009. The Great East Japan Earthquake occurred on March 11, 2011. First-year students in one school had received education on PMS/PMDD before the earthquake, whereas those in another school had not. We reanalyzed data for 1431 girls (November 2010) and 1489 girls (December 2011) aged 15-18 years.

Results

The severity of PMS/PMDD in students who had received the education program showed no changes between before and after the earthquake. However, students who had not received education showed worsening of the severity of PMS/PMDD.

Conclusion

This study showed education had a possible beneficial effect for the prevention of stress-induced PMS/PMDD.

Premenstrual symptoms interference and equol production status in Japanese collegiate athletes: A cross-sectional study

Aim

Consumption of soy isoflavones reduces the risk of estrogen‐related diseases, such as menopausal symptoms, osteoporosis, and cardiovascular disease. Equol is metabolized from the isoflavone daidzein by intestinal bacteria and has higher bioavailability than other isoflavones. Equol producers are believed to benefit from soybean consumption to a greater extent than non‐producers. Recently, we showed that equol non‐producers were at significant risk of premenstrual syndrome (PMS). Previously, we reported that PMS is a common menstrual problem in female athletes, and almost half of the studied athletes felt a negative effect of premenstrual symptoms on their athletic performance. This study was conducted to evaluate the relation between PMS and equol production status in Japanese collegiate athletes.

Methods

This was a cross‐sectional, observational study that included 88 Japanese female collegiate athletes. Equol production status was determined using urine samples collected after a soy challenge test. The subjects also completed a questionnaire about their premenstrual symptoms and their competitive career.

Results

The prevalence of equol producers was 29.5% in Japanese collegiate athletes. The athletic performance of 54.5% of athletes was found to suffer in competition or in practice due to premenstrual symptoms. In multivariate analysis, equol non‐producers (odds ratio, 3.34; 95% confidence interval, 1.03–12.20) and restriction of bodyweight (odds ratio, 4.94; 95% confidence interval, 1.47–20.00) were shown to be significant risk factors for poor athletic performance.

Conclusion

This study showed a relation between athletic performance and equol production status in Japanese collegiate athletes.

A novel missense mutation affecting the same amino acid as the recurrent PACS1 mutation in Schuurs-Hoeijmakers syndrome

A novel causative variant (c.608G>A, p.Arg203Gln) in PACS1.

A case of atypical Kabuki syndrome arising from a novel missense variant in HNRNPK

A novel causative variant (c. 464T>C, p.Leu155Pro) in the heterogeneous nuclear ribonucleoprotein K (HNRNPK) gene.

Stress fracture and premenstrual syndrome in Japanese adolescent athletes: a cross-sectional study

OBJECTIVES

To investigate the relationship between the occurrence of stress fracture and premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) in Japanese adolescent athletes.

DESIGN

Cross-sectional study.

SETTING

Osaka, Japan.

PARTICIPANTS

A school-based survey on menstruation and school life was conducted using a sample of 1818 Japanese female students who belonged to two public high schools in Japan. Among them, we recruited 394 athletes who had regular menstrual cycles (25-38 days) and completed a questionnaire about their premenstrual symptoms and their competitive career.

MAIN OUTCOME MEASURE

Premenstrual symptoms and the occurrence of stress fracture.

RESULTS

The prevalences of moderate-to-severe PMS and PMDD were 8.9% and 1.3%, respectively, which were the same as in collegiate athletes in a previous study. Premenstrual symptoms disturbed 'Work efficiency or productivity, home responsibilities', 'Relationships with coworkers or family' and 'Athletic performance in training or competition' more severely than menstrual pain (p=0.031, p=0.004 and p<0.001, respectively). 66 athletes (16.8%) reported having experienced a stress fracture. The severity of 'Overeating or food cravings', 'Physical symptoms' and 'Performance in training or competition' in athletes with previous stress fractures were much higher than in those without a history of stress fractures (p=0.015, p=0.008 and p=0.006, respectively). In terms of premenstrual symptoms, 'Physical symptoms' was associated with an increased risk of stress fractures in athletes (OR 1.66, 95% CI 1.06 to 2.62).

CONCLUSIONS

The results from this study indicated that premenstrual symptoms may affect athletic performance and has the risk of stress fractures in adolescent athletes.

Fish Consumption and Premenstrual Syndrome and Dysphoric Disorder in Japanese Collegiate Athletes

STUDY OBJECTIVE

To determine the specific characteristics of premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) in Japanese collegiate athletes, with a focus on their fish consumption.

DESIGN

Cross-sectional study.

SETTING

A university in Osaka, the largest city in western Japan.

PARTICIPANTS AND INTERVENTIONS

The participants were 312 female collegiate students. The study group was composed of 200 students who were members of sport clubs, and the control (nonathletes) group was composed of 112 members of cultural clubs.

MAIN OUTCOME MEASURES

Premenstrual symptoms and social activities.

RESULTS

The prevalence of moderate to severe PMS and PMDD in the study group was the same as in nonathletes. The prominent feature of premenstrual symptoms in athletes was that the severities of 'physical symptoms' and 'performance in training or competition' were much greater than those of nonathletes (P = .003 and P = .002, Mann-Whitney U test). There was a greater effect of PMS and PMDD on athletes, affecting their physical symptoms and performance compared with nonathletes. In terms of dietary habits, 'fish or dried fish' consumption was associated with a decreased risk of poor performance in athletes (odds ratio, 0.61; 95% confidence interval, 0.40-0.92).

CONCLUSION

The results from this study indicate that fish consumption might be positively associated with the relief of PMS/PMDD-induced athletic disturbance.

A PLK4 mutation causing azoospermia in a man with Sertoli cell-only syndrome

About 15% of couples wishing to have children are infertile; approximately half these cases involve a male factor. Polo-like kinase 4 (PLK-4) is a member of the polo protein family and a key regulator of centriole duplication. Male mice with a point mutation in the Plk4 gene show azoospermia associated with germ cell loss. Mutational analysis of 81 patients with azoospermia and Sertoli cell-only syndrome (SCOS) identified one man with a heterozygous 13-bp deletion in the Ser/Thr kinase domain of PLK4. Division of centrioles occurred in wild-type PLK4-transfected cells, but was hampered in PLK-4-mutant transfectants, which also showed abnormal nuclei. Thus, this PLK4 mutation might be a cause of human SCOS and nonobstructive azoospermia.

Premenstrual Syndrome and Premenstrual Dysphoric Disorder in Japanese Collegiate Athletes

STUDY OBJECTIVE

To determine the prevalence and impact of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) in Japanese collegiate athletes, with a focus on their disruption of athletic performance.

DESIGN

Cross-sectional study.

SETTING

A university in Osaka, the largest city in western Japan.

PARTICIPANTS

232 female collegiate athletes.

MAIN OUTCOME MEASURES

Premenstrual symptoms and social activities.

RESULTS

The prevalence of each premenstrual symptom was high. The prevalence of moderate to severe PMS and PMDD was 8.6% and 2.9%, respectively, the same as in general high school students. The athletic performance of 44.3% of athletes was found to suffer in a game or in practice. "Elite athletes" (OR 8.63, 95% CI: 1.22-120.0), "Difficulty concentrating" (OR 3.15, 95% CI: 1.05-10.6), and "Fatigue or lack of energy" (OR 5.92, 95% CI: 1.32-34.5) increased the risk of poor athletic performance.

CONCLUSIONS

This study showed that premenstrual symptoms affect not only the daily activities but also the athletic performance of collegiate athletes.

Four-year study of lamivudine and adefovir combination therapy in lamivudine-resistant hepatitis B patients: influence of hepatitis B virus genotype and resistance mutation pattern

To investigate the efficacy of long-term lamivudine (3TC) and adefovir dipivoxil (ADV) combination therapy in 3TC-resistant chronic hepatitis B virus (HBV) infected patients, we analysed 28 3TC-resistant patients treated with the combination therapy during 47 months (range, 9-75). At 12, 24, 36, and 48 months, the rates of virological response with undetectable HBV DNA (≤ 2.6 log copies/mL) were 56, 80, 86, and 92%, respectively. Among 17 hepatitis B e antigen (HBeAg)-positive patients, HBeAg disappeared in 24% at 12 months, 25% at 24 months, 62% at 36 months, and 88% at 48 months. When HBV genotypes were compared, patients with genotype B achieved virological response significantly more rapidly than those with genotype C (P=0.0496). One patient developed virological breakthrough after 54 months, and sequence analysis of HBV obtained from the patient was performed. An rtA200V mutation was present in the majority of HBV clones, in addition to the 3TC-resistant mutations of rtL180M+M204V. The rtN236T ADV-resistant mutation was observed in only 25% clones. In vitro analysis showed that the rtA200V mutation recovered the impaired replication capacity of the clone with the rtL180M+M204V mutations and induced resistance to ADV. Moreover, rtT184S and rtS202C, which are known entecavir-resistant mutations, emerged in some rtL180M+M204V clones without rtA200V or rtN236T. In conclusion, 3TC+ADV combination therapy was effective for most 3TC-resistant patients, especially with genotype B HBV, but the risk of emergence of multiple drug-resistant strains with long-term therapy should be considered. The mutation rtA200V with rtL180M+M204V may be sufficient for failure of 3TC+ADV therapy.

Intercellular adhesion molecule-1 on synovial cells attenuated interleukin-6-induced inhibition of osteoclastogenesis induced by receptor activator for nuclear factor κB ligand

In a co-culture of osteoclast precursor cells and synovial cells, interleukin-6 (IL-6) induces osteoclast formation. In contrast, in a monoculture of osteoclast precursor cells, IL-6 directly suppresses receptor activator for nuclear factor κB ligand (RANKL)-induced differentiation of osteoclast precursor cells into osteoclasts. In the present study, we explored why the effect of IL-6 differed between the monoculture and the co-culture systems. In the monoculture, mouse osteoclast precursor cell line, RAW 264·7 (RAW) cells were cultured with soluble RANKL (sRANKL) for 24 h or 3 days. sRANKL increased both expression of osteoclastogenesis marker, tartrate-resistant acid phosphatase isoform 5b (TRAP5b) and nuclear factor of activated T cells cytoplasmic 1 (NFATc1), whereas the co-addition of IL-6 decreased them both in a dose-dependent manner. In the co-culture, RAW cells and human synovial cell line, SW982 cells were cultured with IL-6+soluble IL-6 receptor (sIL-6R) for 3 days. TRAP5b and NFATc1 expression reduced by IL-6 was increased by the addition of SW982 cells in a manner dependent upon the number of added cells. IL-6+sIL-6R treatment significantly induced RANKL production in SW982 cells, and anti-RANKL antibody inhibited IL-6+sIL-6R-induced osteoclastogenesis. SW982 cells expressed high levels of ICAM-1 originally, and ICAM-1 expression was increased significantly by IL-6+sIL-6R. Anti-ICAM-1 antibody suppressed IL-6-induced osteoclastogenesis. Finally, in the monoculture system, addition of sICAM-1 dose-dependently restored the expression of TRAP5b reduced by IL-6. Similar results were obtained when the formation of TRAP-positive multi-nuclear cells were examined using mouse bone marrow cells. In conclusion, IL-6 gave different results in the co-culture and monoculture systems because in the co-culture, ICAM-1 from the synovial cells restored osteoclastogenesis suppressed by IL-6.

Radical hysterectomy for invasive cervical cancer during pregnancy: a retrospective analysis of a single institution experience

PURPOSE

To evaluate long-term prognosis and patient safety for a radical hysterectomy in pregnant women with invasive cervical cancer.

PATIENTS AND METHODS

We retrospectively analyzed 12 cases of radical hysterectomy (RH) performed for invasive cervical cancer during pregnancy. Four patients underwent RH with the fetus in situ and another eight patients underwent RH followed by cesarean section.

RESULTS

The median treatment period was 17 weeks of gestation (range: 9 to 39), the mean blood loss was 550.1 +/- 162.5 g (range: 275 to 850). Pelvic lymph node metastases were observed in three patients and parametrial invasion was observed in one patient. Although one patient experienced a recurrence at the vaginal stump, all patients were alive at a median follow-up interval of 105 months (range: 61 to 234).

CONCLUSION

RH during pregnancy can be safely performed even with the fetus in situ and a subsequent cesarean section.

Interferon-gamma is produced by CD8 T cells in response to HLA-A24-restricted hepatitis C virus epitopes after sustained virus loss

Differences in cytotoxic T lymphocyte activity in hepatitis C virus infection may account for the outcome of interferon monotherapy. To investigate this hypothesis, we analysed the response of peripheral CD8(+) T cells that recognized epitopes presented by HLA-A*2402. We synthesized HLA/beta2-microglobulin/peptide complexes using two epitopes. Production of interferon-gamma by CD8(+) T cells in response to plastic-bound monomeric HLA/peptide complex was observed frequently in sustained virus responders (SVR) (n = 13) against all the peptides, NS31296-1304 (the percentage of responding patients, 61.5%) and core 129-137 (53.8%), while no interferon-gamma production was observed in non-responders (NR) (n = 13) for any of the peptides. Tetramer-staining showed the presence of CD8(+) T cells specific for all the peptides except NS31296-1304 in two SVR at the end of interferon monotherapy, although hardly any such cells were found in four NR. Specific killing was observed against peptides NS31296-1304 (3/4) and core 129-137 (1/4) in sustained responders but none in non-responders. These results suggest that the responses of cytotoxic T lymphocytes (CTLs) were induced during interferon therapy in these patients and that interferon-gamma production by CD8(+) T lymphocytes against HCV NS31296-1304 and core 129-137 are well maintained in patients with SVR compared with those with NR. These findings emphasize the importance of the CD8(+) T cell response in controlling HCV infection.

Vigorous response of cytotoxic T lymphocytes associated with systemic activation of CD8 T lymphocytes in fulminant hepatitis B

BACKGROUND

Fulminant hepatitis is a clinical syndrome characterized by sudden and severe liver dysfunction.

METHODS

We analyzed two patients with a superacute form of fulminant hepatitis B and compared findings with those of four patients with acute self-limited hepatitis B, two patients with acute exacerbation of chronic hepatitis B and four healthy individuals.

RESULTS

In fulminant hepatitis, an increased population of human leukocyte antigen (HLA)-DR(+) CD8(+) lymphocytes was observed in peripheral blood by flow cytometry, which was accompanied by the presence of HLA-DR(hi) lymphocytes. The phenotype of CD8(+) T lymphocytes from patients with fulminant hepatitis was mostly that of the effector T lymphocytes in peripheral blood, whereas lymphocytes with CD45RA(-) CCR7(-) phenotype dominated in the liver of these patients. A larger population of hepatitis B virus (HBV)-specific cytotoxic T lymphocytes (CTLs) appeared in peripheral circulation of the fulminant hepatitis patients compared with that in a patient with acute hepatitis. HBV-specific CTLs were highly concentrated in the liver, although epitopes recognized by these CTLs in the peripheral blood and in the liver were similar. Peripheral CTLs were mostly functional as indicated by intracellular perforin and interferon-gamma.

CONCLUSIONS

These results suggest the presence of vigorous activation of CD8(+) T cells in vivo in fulminant hepatitis and the necessity of extensive therapy in patients with this disease.

Linear and whorled naevoid hypermelanosis: a case with systemic involvement and trisomy 18 mosaicism

We describe a 20-year-old woman with trisomy 18 mosaicism, who presented with skeletal anomalies, epilepsy, mental retardation, and linear and whorled naevoid hypermelanosis.

Successful planned pregnancy in a patient with St Jude medical prosthetic mitral valve

A primiparous woman with a St Jude Medical (SJM) mitral valve prosthesis and receiving anticoagulant drug delivered a healthy male infant by spontaneous normal vaginal delivery. Oral warfarin was replaced by subcutaneous heparin at the 6th week of gestation and the dosage of heparin was adjusted to maintain a partial thromboplastin time between 2.0 and 2.5 times the control value. Treatment with heparin was administered during the first trimester and the last 5 weeks of gestation. Warfarin was used between the 13th and 32nd week. Successful pregnancy and delivery in patients with a SJM mitral valve prostheses is possible with careful maintenance of anticoagulation.

Characterization of a phospholipid antigen reacting with serum antibody in patients with peripheral neuropathies and paraproteinemia

A phospholipid antigen that reacted with the serum antibody from a patient with peripheral neuropathy and paraproteinemia with both impaired sensory and motor functions, but not with sera from patients with only impaired sensory functions and healthy controls, was purified from bovine cauda equina as a minor component with a concentration of about 0.6 microg per gram wet-weight tissue. The structure of the phospholipid was characterized as lysophosphatidylinositol by means of thin-layer chromatography, gas-liquid chromatography, and negative-ion fast-atom-bombardment mass spectrometry. The major fatty acid component of this phospholipid was stearic acid (> 81%). Our data suggest the possible involvement of a lysophospholipid antigen in the immunopathogenesis of peripheral neuropathies with severe motor and sensory dysfunctions. There is an intriguing possibility that the difference in immunoreactivity of serum antibodies may underlie the differential clinical manifestations in patients with peripheral neuropathy and paraproteinemia.

Staging of palpable T1-2 invasive breast cancer with helical CT

BACKGROUND

The purpose of this study was to evaluate the accuracy of contrast-enhanced high resolution helical computed tomography (CT) for assessing locoregional staging of palpable T1-2 invasive breast cancer.

METHODS

Helical CT studies of 156 lesions from 156 patients with invasive breast cancer before breast-conserving surgery were examined. A lesion was defined as positive if focal enhancement was detected by CT within 100 seconds after contrast material administration. After resection, tumors were histopathologically mapped and comparison made with the extent of contrast enhancement.

RESULTS

Helical CT enabled detection of all 156 index tumors. CT enabled detection of 28 of 43 multifocal lesions (65%) and five of five multicentric lesions (100%). In 24 of 33 lesions (73%), CT revealed additional cancers not seen on mammography. The extent of tumor significantly correlated with CT measurements (r=0.76, p<0.0001).

CONCLUSION

Helical CT of the breast is an accurate preoperative imaging modality for assessing the locoregional staging of T1-2 invasive breast cancer.

Anti-Gal-C antibodies in GBS subsequent to mycoplasma infection: evidence of molecular mimicry

The authors previously reported the presence of antibody against galactocerebroside (Gal-C) in sera from patients with Guillain-Barré syndrome subsequent to Mycoplasma pneumoniae infection. Anti-Gal-C antibody activities in these sera were inhibited specifically by the M. pneumoniae reagent. A rabbit anti-Gal-C antibody recognized several glycolipids in M. pneumoniae. These data show that a Gal-C-like structure is present in M. pneumoniae, indicative of molecular mimicry between a major myelin glycolipid, Gal-C, and M. pneumoniae.

Variability in immunohistochemistries of IgM M-proteins binding to sulfated glucuronyl paragloboside

Serum IgMs from 4 of 12 patients with polyneuropathy and IgM M-proteins that bind to sulfated glucuronyl paragloboside (SGPG) strongly immunostained the human peripheral nerve myelin (group A), whereas those from the other eight patients strongly immunostained the cytoplasm of the Schwann cells surrounding the myelin sheath with only weak staining of the myelin (group B). Strong immunostaining of peripheral myelin by IgMs from group A patients may be due to the strong cross-reactivities against P0 and peripheral myelin protein-22 (PMP-22), which are localized in compact myelin. Only three patients (all in group B) showed some response to the immunotherapies. Weak reactivities to P0 and and PMP-22 might indicate the possibility of improvement after the immunotherapies.

Crystallization and preliminary X-ray analyses of quaternary, ternary and binary protein-DNA complexes with involvement of AML1/Runx-1/CBFalpha Runt domain, CBFbeta and the C/EBPbeta bZip region

Three types of protein-DNA complexes, AML1/Runx-1/CBFalpha(Runt)-CBFbeta-C/EBPbeta(bZip)-DNA (CBFalpha-beta-C/EBPbeta-DNA), AML1/Runx-1/CBFalpha(Runt)-C/EBPbeta(bZip)-DNA (CBFalpha-C/EBPbeta-DNA) and AML1/Runx-1/CBFalpha(Runt)-DNA (CBFalpha-DNA), were crystallized. The crystals were all orthorhombic and belonged to space groups C222(1), P2(1)2(1)2 and P2(1)2(1)2(1), respectively. The resolutions of CBFalpha-beta-C/EBPbeta-DNA and CBFalpha-C/EBPbeta-DNA crystals were both 3 A, while that of the CBFalpha-DNA crystal was 2.65 A. Complete data sets were collected for all of the native crystals, along with MAD and MIR data sets for CBFalpha-beta-C/EBPbeta-DNA. The heavy-atom site was determined using MAD data for a gold derivative of CBFalpha-beta-C/EBPbeta-DNA.

Guillain-Barré syndrome associated with IgG monospecific to ganglioside GD1b

The authors examined serum antiglycolipid antibodies in 445 patients with Guillain-Barré syndrome (GBS). Among them, nine had anti-GD1b IgG antibodies with no reactivity to other glycolipids tested. All those patients had sensory disturbance, and none had the primary axonal form. Anti-GD1b IgG antibodies may bind to primary sensory neurons and paranodal myelin, where GD1b is localized, and be involved in the pathogenesis of sensory disturbance and demyelination. However, more study is needed to substantiate the roles of anti-GD1b IgG antibodies.

Structural analyses of DNA recognition by the AML1/Runx-1 Runt domain and its allosteric control by CBFbeta

The core binding factor (CBF) heterodimeric transcription factors comprised of AML/CBFA/PEBP2alpha/Runx and CBFbeta/PEBP2beta subunits are essential for differentiation of hematopoietic and bone cells, and their mutation is intimately related to the development of acute leukemias and cleidocranial dysplasia. Here, we present the crystal structures of the AML1/Runx-1/CBFalpha(Runt domain)-CBFbeta(core domain)-C/EBPbeta(bZip)-DNA, AML1/Runx-1/CBFalpha(Runt domain)-C/EBPbeta(bZip)-DNA, and AML1/Runx-1/CBFalpha(Runt domain)-DNA complexes. The hydrogen bonding network formed among CBFalpha(Runt domain) and CBFbeta, and CBFalpha(Runt domain) and DNA revealed the allosteric regulation mechanism of CBFalpha(Runt domain)-DNA binding by CBFbeta. The point mutations of CBFalpha related to the aforementioned diseases were also mapped and their effect on DNA binding is discussed.

Three-dimensional helical CT of the breast: accuracy for measuring extent of breast cancer candidates for breast conserving surgery

OBJECTIVE

To evaluate the accuracy of three-dimensional (3D) helical computed tomography (CT) for assessing the extent of breast cancer of candidates for breast conserving surgery.

METHODS

Results of helical CT were studied in 144 lesions of 144 patients with breast cancer before breast-conserving surgery. A lesion was defined as positive if focal enhancement was detected by CT within 100 s after contrast material administration. After resection, tumors were histopathologically mapped and correlated with the extent of 3D images.

RESULTS

Helical CT enabled detection of 143 tumors but not of one ductal carcinoma in situ (DCIS). The median deviation of the tumor extension revealed by 3D helical CT images from pathological assessment was 7.7 mm (range 0-60 mm). The extent of tumors was significantly correlated with CT measurements (r = 0.714, p < 0.0001). By multivariate analysis, the presence of invasive tumors with intraductal extensions beyond the edge of the invasive tumor and histologic type (DCIS) were significant risk factors for deviation of the tumor extension revealed by 3D helical CT images from pathological assessment.

CONCLUSION

Three dimensional helical CT of the breast is an accurate preoperative imaging modality for assessing the extent of breast cancer candidates for breast conserving surgery.

[Helical CT of the breast: detection of intraductal spread and multicentricity of breast cancer]

PURPOSE

This study was performed to evaluate the clinical utility of postcontrast helical CT (HCT) scan for the detection of intraductal spread (DS) and multicentricity of breast cancer.

MATERIALS AND METHODS

DS and multicentricity in 84 patients with invasive ductal carcinoma were evaluated by preoperative postcontrast HCT. The HCT protocol of 3-mm section width and 3 mm/sec table speed was used with the patients in a supine position. Scanning started 70sec after beginning the intravenous injection of 90 ml (27 gI) of contrast material at the rate of 1.5 ml/sec. The three-dimensional images were displayed.

RESULTS

Eighty-four of 84 main tumors (100%) were shown as enhanced masses by postcontrast HCT. The sensitivity and specificity of HCT for the detection of DS and multicentricity were 60.0% (18/30) and 88.9% (48/54), and 88.9% (16/18) and 90.9% (60/66), respectively. When DS and multicentric lesions were combined, the sensitivity and the specificity were 76.3% (29/38) and 89.1% (41/46), respectively.

CONCLUSION

HCT of the breast is effective in detecting DS and multicentric lesions of breast cancer and might be useful in helping surgeons to successfully perform breast-conserving surgery.

Primary retroperitoneal mucinous cystadenocarcinoma: report of a case

A case of primary retroperitoneal mucinous cystadenocarcinoma is presented. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) examinations demonstrated a large cystic tumor with solid excrescences. Angiographic examination demonstrated an avascular area with small areas of faint blush. It must be borne in mind that mucinous cystadenocarcinoma originating from the retroperitoneum can occur, although it is very rare.

[Localizing methods of primary hyperparathyroidism and those results]

The results of several pre-operative localizing methods and pathological findings were compared in 11 patients with primary hyperparathyroidism. 1. The accuracy rate was highest with selective blood sampling from the thyroid vein and MRI, which was 75% with both methods. The 3rd was dual photon scintigraphy, the accuracy rate being 62.5%. The 4th was ultrasonography, 57.1%, and the rate was lowest with CT, 25%. 2. MRI-a new localizing method-has a weak point that it cannot differentiate lymph nodes from parathyroid adenoma/hyperplasia. 3. Not to overlook small lesion of primary hyperplasia, several localizing methods should be performed before initial neck exploration.

[Clinical evaluation of Fuji computed radiography (FCR) by physicians including non-radiologists]

In Niigata university hospital, most of conventional radiography were changed to FCR from July 1988. To evaluate its clinical utility, questionnaires relating to FCR image were distributed to all physicians including non-radiologists in the hospital after three months. The ratio of the physicians evaluated FCR image to be better than conventional image was 75% in chest radiography, 64% in abdominal radiography. FCR tomography of bone, joint, cranium and chest was also evaluated to be better than conventional by most of the physicians. Reduced size of the film and difficulty in detecting interstitial shadows of the lung were mentioned to be the fault of FCR.

[Reference line for delineation of the intraparotid facial nerve on MRI]

Exact identification of intraparotid facial nerve is important in surgical management of parotid tumors. To delineate the intraparotid facial nerve on MRI, we proposed a new reference line, which was drawn between the inferior margin of the bone marrow of the atlas and superior margin of the bone marrow of the mandible on midsagittal section. This reference line crossed with orbito-meatal line at the mean angle of 37 +/- 3 degrees. By scanning parallel to this line, intraparotid facial nerve was clearly identified in 19 (79%) of 24 normal parotid glands.

[Clomiphene-HMG ovarian stimulation in human in vitro fertilization and embryo transfer]

In a program for in vitro fertilization and embryo transfer, laparoscopies for oocyte aspiration were performed in 40 cycles in 36 normally menstruating women with irreparable tubal diseases (IVF patients) who received clomiphene citrate (CC) and human menopausal gonadotropin (hMG). An intramuscular injection of human chorionic gonadotropin (hCG) was given to all patients after completion of follicular maturation. Fourteen cycles in 13 spontaneously ovulating women (control patients), also stimulated with CC and hMG, were adequately monitored to identify the appearance of the spontaneous luteinizing hormone (LH) surge. The follicular maturation was followed by daily ovarian ultrasonographic examination and serum estradiol estimations. Just before the LH surge the diameter of the leading follicle was 20.2 +/- 0.7 (mean +/- S.E.) mm and the serum estradiol concentration per follicle was 384.1 +/- 16.3pg/ml in the control patients. In the IVF patients the former was 20.6 +/- 0.3mm and the latter was 305.8 +/- 13.3pg/ml prior to hCG administration. When the relationship of follicular size to the rates of oocytes recovery, maturation, fertilization and cleavage was examined, larger follicles (3ml less than or equal to follicular fluid volume) showed good results. Of the 152 oocytes that were recovered from these IVF patients, 96 (63.2%) were fertilized and 79 (52.0%) cleaved. Three pregnancies resulted from 35 embryo transfers.

Thorotrast-induced multiple primary malignant tumors of the liver--cholangiocarcinoma and malignant hemangioendothelioma

A case of multiple primary malignant tumors of the liver (cholangiocarcinoma and malignant hemangioendothelioma) that developed 40 years after Thorotrast administration is described, with radiological and autoradiographic findings. The estimated organ dose to the liver was approximately 580 rads.

[Development of a fetoscope and its clinical application]

One of the major goals in modern obstetrics is to provide more detailed informations of prenatal fetal physiology. Since 1972, more than 200 amniocentesis were performed in our hospital and the importance of prenatal genetic diagnosis has been recognized. But amniocentesis has the limitations which are 1) the lack of expression of many single gene hereditary disorders in amniotic fluid and its cells, 2) the large percentage (90%) of nonviable fetal cells in any given sample, 3) the length of time required to culture fetal cells. Accordingly the necessity of development of other methods to obtain further direct data on the fetus from the uterine cavity has been indicated. Among gynecological endoscopies, fetoscopy which is direct visualization of the fetus by introduction of an endoscope into the amniotic cavity is expected to obtain direct information from the uterine environment in pregnant women. By our newly developed fetoscope, we investigated clinical indications and contraindications of fetoscopy as well as future possibilities of this endoscope. Our present study indicates that further developments and future benefits of fetoscopy entirely depend on the progress of laboratory techniques which can provide more accurate data through specimens obtained fetoscopy.