A case of pancreatic PEComa with prominent inflammatory cell infiltration: the inflammatory subtype is a distinct histologic group of PEComa

BACKGROUND

PEComa is a mesenchymal tumor that can occur in various organs including the uterus and soft tissues. PEComas are composed of perivascular epithelioid cells, and angiomyolipoma (AML), clear cell sugar tumor (CCST), and lymphangiomyomatosis (LAM) are considered lesions of the same lineage as tumors of the PEComa family. Histologically, a common PEComa shows solid or sheet-like proliferation of epithelioid cells. This is accompanied by an increase in the number of dilated blood vessels. Here, we report a case of pancreatic PEComa with marked inflammatory cell infiltration.

CASE PRESENTATION

A 74-year-old male patient underwent an appendectomy for acute appendicitis. Postoperative computed tomography and magnetic resonance imaging revealed a 30 × 25 mm non-contrast-enhanced circular lesion in the tail of the pancreas. The imaging findings were consistent with a malignant tumor, and distal pancreatectomy was performed. Histologically, most area of the lesion was infiltrated with inflammatory cells. A few epithelioid cells with large, round nuclei, distinct nucleoli, and eosinophilic granular cytoplasm were observed. Spindle-shaped tumor cells were observed. Delicate and dilated blood vessels were observed around the tumor cells. Immunohistochemically, the atypical cells were positive for αSMA, Melan A, HMB-45, and TFE3. The cytological characteristics of the tumor cells and the results of immunohistochemical staining led to a diagnosis of pancreatic PEComa.

CONCLUSIONS

A histological variant known as the inflammatory subtype has been defined for hepatic AML. A small number of tumor cells present with marked inflammatory cell infiltration, accounting for more than half of the lesions, and an inflammatory myofibroblastic tumor-like appearance. To our knowledge, this is the first report of pancreatic PEComa with severe inflammation. PEComa is also a generic term for tumors derived from perivascular epithelioid cells, such as AML, CCST, and LAM. Thus, this case is considered an inflammatory subtype of PEComa. It has a distinctive morphology that is not typical of PEComa. This histological phenotype should be widely recognized.

[A Case of Gastric Cancer with Pulmonary Carcinomatous Lymphangitis and Disseminated Carcinomatosis of the Bone Marrow Responding to S-1 plus Cisplatin Chemotherapy]

A 63-year-old man was admitted to a hospital owing to shortness of breath. He was diagnosed as having gastric cancer with pulmonary carcinomatous lymphangitis(PCL)and disseminated carcinomatosis of the bone marrow(DCBM). Regarding tumor markers, carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)levels increased to 332 ng/ mL and 921 U/mL, respectively. Since the disease was also accompanied by disseminated intravascular coagulation(DIC), S- 1 plus cisplatin chemotherapy was started immediately(S-1 120 mg/body administered for 21 days and cisplatin 60 mg/m2 administered on day 8, 35 days for a course). Approximately 2 weeks after the initiation of chemotherapy, the patient's respiratory symptoms improved, and he recovered from DIC. After 2 chemotherapy courses, tumor marker levels decreased (CEA 9.3 ng/mL and CA19-9 314 U/mL), and the patient continued to receive chemotherapy without the deterioration of his physical condition for 5 months. However, he experienced fatigue after 4 courses, because of the progression of gastric cancer. Although the regimen was changed to ramucirumab plus paclitaxel chemotherapy, the patient died 8 months after the initiation of chemotherapy. An accumulation of cases is needed to establish treatment strategies for gastric cancer with PCL and/or DCBM.

Gastric cancer simultaneously complicated with extrahepatic bile duct metastasis and portal vein tumor thrombus: a case report

BACKGROUND

Gastric cancer metastatic to the extrahepatic bile duct or accompanied by portal vein tumor thrombus (PVTT) is rare. To our knowledge, there have been no cases complicated with both of these factors.

CASE PRESENTATION

A 72-year-old man presented with icterus and melena. A biochemical blood test showed abnormal values for hepatobiliary enzymes and a tumor marker, and abdominal computed tomography scan revealed wall thickening of the lower bile duct with intra- and extra-hepatic bile duct dilatation and PVTT. A biopsy of the lower bile duct during endoscopic retrograde cholangiopancreatography demonstrated a moderately differentiated tubular adenocarcinoma. Moreover, gastroduodenoscopy showed a type 3 tumor at the lesser curvature of the gastric antrum, and an endoscopic biopsy demonstrated a moderately differentiated tubular adenocarcinoma. We diagnosed concomitant gastric cancer and distal bile duct accompanied by PVTT, and pancreatoduodenectomy with combined resection of the portal vein was performed. The resected specimen revealed a tumor in the lesser curvature of the gastric antrum and circumferential wall thickening in the lower bile duct. In pathological findings, infiltration of a moderately differentiated tubular adenocarcinoma from the mucosal layer to the subserosal layer of the stomach was observed. In contrast, a moderately differentiated tubular adenocarcinoma demonstrating the same histological type as the gastric cancer had spread not to the mucosal layer but mainly to the fibromuscular layer of the lower bile duct. Immunohistochemical staining showed identical patterns between gastric cancer and the bile duct tumor: negativity for cytokeratin 7 (CK7), and positivity for CK19 and 20. Therefore, the final diagnosis was extrahepatic bile duct metastasis from gastric cancer with PVTT. Unfortunately, multiple liver metastases occurred in the early postoperative period and chemotherapy was conducted, but the patient died 12 months after the surgery.

CONCLUSIONS

In the diagnosis of extrahepatic bile duct metastasis, immunohistochemical staining of gastric cancer and the bile duct tumor was essential and helpful as decisive evidence.

Surgical resection for small bowel obstruction due to right ovarian metastasis after ileocecal resection for cecal cancer: A case report

Although oophorectomy for ovarian metastasis from colorectal cancer is encouraged to improve the prognosis, that is also performed to relieve the symptom such as abdominal distention. We report a surgical case of intestinal obstruction due to ovarian metastasis after ileocecal resection for cecal cancer diagnosed at 77 years old.

Influence of obesity and epicardial fat on the progression of electrical and structural remodeling in a canine obese rapid atrial pacing model

Background

Metabolic syndrome is a cluster of conditions including obesity, insulin resistance, hypertension, and abnormal cholesterol, which increases the cardiovascular risk. Metabolic syndrome or obesity has been reported to provide systemic inflammation and oxidative stress. Increased epicardial fat volume is a manifestation of obesity or metabolic syndrome. Those systemic and local conditions related to obesity or metabolic syndrome have been linking to the risk of atrial fibrillation (AF). The underlying mechanisms of obesity linking epicardial fat to AF progression have not been fully examined.

Purpose

To investigate the impact of obesity linked to epicardial fat on electrophysiologic and anatomical AF substrates.

Methods

Twenty dogs aged 3 years were divided into four groups (n=5 per each): normal diet for over 20 weeks (control group [median body weight: 12.0 kg]), rapid atrial pacing (RAP) for last 4–15 (median 8) weeks during a normal diet for the same period (RAP group [10.5 kg]), high-fat diet (HFD) maintained for over 20 weeks without RAP (MetS group [16.0 kg]), and RAP for last 4–12 (median 6) weeks during HFD maintained for 24 weeks (MetS-RAP group [17.0 kg]), respectively. Activation/voltage maps of the atria during sinus rhythm were created with Ensite NavX mapping system. The effective refractory period (ERP) at 5 left atrial (LA) and pulmonary vein (PV) sites (LA appendage [LAA], LA body, right and left superior PVs, and inferior PV), and AF inducibility by burst LAA pacing were determined. At study completion, hearts were excised for histopathological and gene expression analyses.

Results

The LA pressure was more significantly increased in MetS than the MetS-RAP, RAP, and control groups (22.5 [17–28.8] mmHg vs. 14.0 [10.5–16.3] mmHg, 10.5 [7.4–17.2] mmHg and 10.7 [9.6–13.5] mmHg, respectively, P<0.05). The LA/PV ERP at a basic cycle length of 400 ms was shorter in the MetS-RAP and RAP than MetS and control groups (118±39 ms and 122±44 ms vs. 136±18 ms and 155±39 ms, respectively, P<0.05). Short duration AF was more induced in the MetS and MetS-RAP than RAP and control groups (3 [0–5.5] sec and 2 [0.5–3.5] sec vs. 0 [0–4.5] sec and 0 [0–0] sec, P<0.05). Histological examinations showed the fatty infiltration extending from epicardial fat increased more in the Mets and Mets-RAP than RAP and control groups (Figure). The Fibronectin 1 and collagen I/III mRNA levels increased more in the MetS-RAP and AF than MetS and control groups.

Conclusions

AF vulnerability was associated with increased LA pressures and fibrofatty infiltration from epicardial fat in the MetS group, and with fibrofatty infiltration from epicardial fat with subtle fibrosis in the MetS-RAP group. This suggested that fibrofatty infiltration and epicardial fat plays an important role in AF pathogenesis in obese patients.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research (KAKENHI)

Hepatic Stellate Cells Play a Functional Role in Exacerbating Ischemia-Reperfusion Injury in Rat Liver

PURPOSE

The involvement of hepatic stellate cells (HSCs) with ischemia-reperfusion (I/R) injury in rat liver was examined using gliotoxin, which is known to induce HSC apoptosis.

METHODS

Male Sprague-Dawley rats were used. HSC was represented by a glial fibrillary acidic protein (GFAP)-positive cell. Liver ischemia was produced by cross-clamping the hepatoduodenal ligament. The degree of I/R injury was evaluated by a release of aminotransferases. Sinusoidal diameter and sinusoidal perfusion rates were examined using intravital fluorescence microscopy.

RESULTS

Gliotoxin significantly decreased the number of GFAP-positive cells 48 h after dosing (2.50 ± 0.19% [mean ± SD] in the nontreated group vs. 1.91 ± 0.46% in the gliotoxin-treated group). Liver damage was significantly suppressed by the pretreatment with gliotoxin. Sinusoidal diameters in zone 3 were wider in the gliotoxin group (10.25 ± 0.35 µm) than in the nontreated group (8.21 ± 0.50 µm). The sinusoidal perfusion rate was maintained as well in the gliotoxin group as in normal livers, even after I/R.

CONCLUSIONS

Pretreatment with gliotoxin significantly reduced the number of HSCs in the liver and further suppressed liver injury following I/R. It is strongly suggested that HSCs play a functional role in exacerbating the degree of I/R injury of the liver.

Effect of genetic polymorphisms of azathioprine-metabolizing enzymes on response to rheumatoid arthritis treatment

Azathioprine (AZA) is increasingly being prescribed to rheumatoid arthritis (RA) patients. Following oral administration, AZA is converted into its active form. Inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE) patients with low thiopurine (S)-methyltransferase (TPMT) activity tend to respond well to AZA therapy. In a previous study of Japanese SLE patients under low-dose AZA therapy, the group with the 94C>A mutation in inosine triphosphatase (ITPA) showed greater improvement in their disease activity index. However, it is not yet clear how genotypes relate to responsiveness to RA treatment. The genotypes ITPA 94C>A, TPMT*3C, NUDT15 595C>T, GST-M1, GST-T1 and MRP4/ABCC4 2269G>A of Japanese patients with RA were determined. The relationship between these genotypes and response to AZA therapy was evaluated using the Disease Activity Score 28 (DAS28) and various medical data. Of the 22 patients 15 had the ITPA 94C/C genotype, 7 had the ITPA 94C/A genotype, none had the TPMT*3C mutation, 4 had the NUDT15 595C>T mutation, 8 had the GST-M1 and T1 null genotypes and 9 had the MRP4/ABCC4 2269G>A mutation. Changes in DAS28 at 6 months after baseline were similar in both ITPA genotype groups. However, the maintenance dose of AZA was significantly lower in the C/A group than in the C/C group (0.85±0.30 mg/kg/day vs. 1.2±0.46 mg/kg/day, respectively; p = 0.043). The ITPA 94C/A group showed the same response to RA treatment as the C/C group, but at a lower dose. This demonstrates that RA patients with the ITPA 94C>A mutation are more responsive to AZA.

Suppression of infliximab antibody levels by azathioprine in patients with rheumatoid arthritis

In rheumatoid arthritis (RA) treatment, the concomitant use of methotrexate has been shown to reduce the incidence of antibodies to infliximab (ATI), on the other hand, it is unclear whether azathioprine can reduce ATI production. We enrolled a total of 10 Japanese adult patients with RA who were treated with infliximab concomitantly with methotrexate or azathioprine. Serum concentrations of infliximab and ATI of these patients were measured. The mean serum infliximab concentrations was 1.6±1.3 μg/ml in patients with methotrexate and 1.0±0.5 μg/ml in patients with azathioprine. Serum ATI concentrations were below the limit of quantitation in 4 of 5 patients in each group. The results from the present study suggest that azathioprine suppresses ATI production.

Heel movement in horses: comparison between glued and nailed horse shoes at different speeds

REASONS FOR PERFORMING STUDY

It has been suggested that the heel of the horse's hoof expands in the stance phase and this reduces the concussion at impact and helps pump blood into the hoof. Therefore, farriers usually leave a gap in the heel region when using the traditional nailed shoe. Recently glued shoes which are attached firmly to the heel have been developed and these could restrict heel movement.

OBJECTIVE

To compare the degree of mediolateral heel movement between glued and nailed shoes.

METHODS

Seven Thoroughbreds were used. Either their fore- or hind hooves were shod with plain aluminium shoes, attached first with glue and later with nails. Measurements were collected continuously with a displacement sensor fixed between the medial and lateral hoof walls at the heel. The horses ran on a treadmill at a walk (1.8 m/s), trot (3.5 m/s), canter (8 m/s) and gallop (12 m/s). The mediolateral heel movement in a nonweightbearing position was set at zero for each hoof and thus positive and negative numbers represented expansion and contraction, respectively. Average values of 10 consecutive strides at each speed were compared between the 2 shoeing methods by paired t test.

RESULTS

At all running speeds, the heels expanded in the first 70-80% of the stance phase and contracted at breakover. The total heel movement calculated as the sum of the maximum expansion and contraction value was less with glued shoeing than with nailed shoeing for walking (all limbs), trotting (all limbs), cantering (leading forelimb and both hindlimbs) and galloping (both hindlimbs).

CONCLUSIONS

Glueing restricted heel movement, suggesting possible interference with shock absorption and blood pumping in the hoof. Further study is needed to evaluate the influence of glued shoeing on hoof mechanics.

Marked difference between adults and children in Bordetella pertussis DNA load in nasopharyngeal swabs

Bordetella pertussis is the aetiologic agent of whooping cough, a common cause of severe respiratory illness in children and prolonged mild cough in adults. To understand some of the reasons for differences in clinical symptoms between adults and children, we measured B. pertussis DNA loads in nasopharyngeal swabs (NPS) from 19 adults and 40 children (including 14 infants) by quantitative IS481 real-time PCR. All cases had been pre-diagnosed with the B. pertussis-specific loop-mediated isothermal amplification method. The mean PCR threshold cycles for adult and child NPS were 34.9 and 27.1, respectively, indicating a significantly lower B. pertussis DNA load in adults than in children (p <0.001). Moreover, adults had very low DNA loads during both early and later stages of the disease. When corresponding bacterial loads in NPS were calculated for B. pertussis Tohama cells using a standard curve, the mean number of bacterial cells taken with a rayon-tipped swab from an adult, older child and infant was estimated to be 320 (95% CI 120-910), 2.1 × 10⁴(95% CI 5.3 × 10³ to 8.3 × 10⁴) and 1.1 × 10⁶ cells (95% CI 1.2 × 10⁵ to 8.9 × 10⁶), respectively. This indicates that the B. pertussis load in NPS is closely correlated with patient age. Our observations suggest that adult pertussis is characterized by a lower bacterial load in the nasopharynx, resulting in milder symptoms and negative cultures.

Role of dietary fibres, intestinal hypermotility and leukotrienes in the pathogenesis of NSAID-induced small intestinal ulcers in cats

BACKGROUND

Recent advances in endoscopy have revealed that non-steroidal anti-inflammatory drugs (NSAIDs) often cause ulcers in the human small intestine. However, the mechanism of intestinal ulcer formation is still unclear.

AIMS

The role of dietary fibre (DF), intestinal motility and leukotrienes (LTs) in the formation of small intestinal ulcers induced by indomethacin (IND) was investigated in cats.

METHODS

Several types of diets containing DF at various percentages were given to animals twice daily during the experiment. IND was administered orally once daily after the morning meal for 3 days, and the area of mucosal lesions in the intestine was measured. Gastrointestinal motility was measured using a telemetry system in conscious cats implanted with force transducers.

RESULTS

In cats fed regular dry food containing 2.8% DF, IND (3 mg/kg, p.o.) significantly increased the motility of the lower half of the small intestine and produced many severe lesions; the total lesion area was 7.7 (SEM 2.0) cm(2) (n = 5). The lesions were markedly decreased with the low-DF diet (0.4%) and increased with the high-DF diet (7.2%). The lesion area was 0.1 (SEM 0.1) cm(2) (p<0.05) and 18.2 (SEM 4.1) cm(2) (p<0.05), respectively. Supplementation with insoluble DF (6% cellulose), but not soluble DF (pectin), in the low-DF diet increased the lesion area significantly. The hypermotility and lesion formation in the small intestine induced by IND were significantly (p<0.05) inhibited by AA-861 (a 5-lipoxygenase inhibitor), pranlukast (a LT receptor antagonist) or atropine.

CONCLUSIONS

Insoluble DF, intestinal hypermotility, leukotrienes and cholinergic pathways are implicated in the pathogenesis of small intestinal ulcers induced by NSAIDs.

Short communication: expression of human endogenous retrovirus-R gene links to differentiation of squamous cells

To investigate the biological roles of human endogenous retrovirus-R (HERV-R) in vivo, we established transgenic rats carrying the full sequence of the viral genome with control of its own long terminal repeat promoter. The Env protein was expressed on the surface of the epidermis of fetal HERV-R transgenic rats on day 10 of gestation. The epidermal Env expression disappeared by day 18 of gestation. After day 18 of gestation, the Env protein was detected in the prickle layer of the esophageal epithelium of transgenic rats. Interestingly, it was not detected in the basal layer of the epithelium, and the expression in the granular layer was weaker than in the prickle layer. These findings suggest that expression of HERV-R is linked not only to the development but also to the differentiation of squamous cells. Next, we examined alterations in the expression of the HERV-R env gene in cultured human squamous cells after exposure to all-trans retinoic acids (ATRA). The env expression was increased by ATRA in a dose-dependent manner, while the expression of transglutaminase 1 (TGM1), a terminal marker for squamous differentiation, was decreased. TGM1 is expressed in the granular layer of the squamous epithelium, and ATRA suppresses the differentiation of cultured squamous cells. Thus, these in vitro data also suggest that HERV-R expression is regulated by a mechanism closely related to the differentiation of squamous cells. This study is the first to demonstrate the association of HERV-R expression and differentiation of squamous cells.

Antinociceptive efficacy of antidepressants: assessment of five antidepressants and four monoamine receptors in rats

PURPOSE

For assessment of the antinociceptive potency of antidepressants, we compared the antinociceptive effects of serotonin selective reuptake inhibitors (SSRIs) and classical tricyclic antidepressants (TCAs) in rats. We also attempted to elucidate the monoamine receptor subtypes predominantly involved in the antinociceptive effect of antidepressants.

METHODS

Male Wistar rats received SSRIs (sertraline, fluvoxamine, and citalopram) or TCAs (imipramine and desipramine) intraperitoneally, and the reaction time until pain response in the hot plate test and licking time in the formalin test were measured 60 min later. We also observed the effects of prazosin (an alpha(1) antagonist), WB-4101 (a selective alpha(1A) antagonist), yohimbine (an alpha(2) antagonist), WAY-100635 (a selective 5-HT(1A) antagonist), and ketanserin (a 5-HT(2) antagonist), which were simultaneously administered with imipramine or desipramine, on the antidepressant-induced antinociceptive effect in the formalin test.

RESULTS

In the hot plate test, desipramine, 20 mg.kg(-1), but not imipramine or sertraline, produced a significant increase in reaction time. In the formalin test, desipramine and imipramine produced significant reductions in the licking time at over 5 mg.kg(-1) and at over 10 mg.kg(-1), respectively. These reductions were nearly complete at 20 mg.kg(-1). On the other hand, both SSRIs induced significant reductions in the licking time only at 20 mg.kg(-1). Prazosin, WB-4101, and ketanserin significantly antagonized the antinociceptive effect of 10 mg.kg(-1) of imipramine. However, imipramine-induced antinociception was not affected by yohimbine and WAY-100635. Prazosin and ketanserin also significantly suppressed antinociception by 5 mg.kg(-1) of desipramine.

CONCLUSION

These findings suggest that classical TCAs are likely to have a therapeutic advantage over SSRIs for pain control. In addition, it is likely that central alpha(1) adrenoceptors and 5-HT(2) receptors are predominantly involved in imipramine- and desipramine-induced antinociception.

MR imaging of the anterior cruciate ligament: value of thin slice direct oblique coronal technique

PURPOSE

The value of the thin slice direct oblique coronal technique, which is parallel to the anterior cruciate ligament (ACL), was assessed in the evaluation of ACL injury in comparison with conventional oblique sagittal and coronal images.

MATERIAL AND METHODS

A thin slice direct oblique coronal technique was developed and applied clinically to 62 patients after conventional oblique sagittal and coronal images had been obtained. MR images of these 62 patients (24 with tears and 38 without tears) with an arthroscopic correlation were evaluated by three radiologists who were unaware of the arthroscopic results. The diagnostic accuracy of these new images was compared with that of oblique sagittal and coronal images by ROC analysis.

RESULTS

Conventional oblique sagittal and coronal images for the diagnosis of ACL tears revealed accuracies of 82%, 84%, and 84%, sensitivities of 92%, 92%, and 96% and specificities of 76%, 79%, and 76% for the three reviewers, respectively. On thin slice direct oblique coronal images, specificities of 97%, 97%, and 97%, sensitivities of 96%, 96%, and 96%, and accuracies of 97%, 97%, and 97% were obtained, respectively. Diagnostic ability was significantly better with direct oblique coronal images (mean area under the ROC curve [Az]=0.99) than with conventional oblique sagittal and coronal images (Az=0.91) (p<0.05).

CONCLUSION

The addition of thin slice direct oblique coronal images significantly improved specificity and accuracy in the diagnosis of ACL tears.

Conformational analysis and docking study of potent factor XIIIa inhibitors having a cyclopropenone ring

A conformational analysis and docking study of potent factor XIIIa inhibitors having a cyclopropenone ring were carried out in an attempt to obtain structural insight into the inhibition mechanism. First, stable conformers of the inhibitors alone were obtained from the conformational analysis by systematic search and molecular dynamics. Next, a binding form model of factor XIIIa was built based on an X-ray crystal structure of the enzyme. Finally, the docking study of the inhibitors into the model's binding site was performed. From the resulting stable complex structures, it was found that the cyclopropenone ring fits the active site located at the base of the binding cavity with high complementarity. The carbonyl oxygen of the cyclopropenone ring formed a hydrogen bond to the indole NH group of Trp279 and the terminal carbon atom of the reactive C=C double bond was in close proximity to the sulfur atom of the catalytic residue, Cys314. This binding mode suggests a possible inhibition mechanism, whereby the cysteine residue reacts with the cyclopropenone ring of the inhibitor, forming an enzyme-ligand adduct. In addition, the higher interaction energies between factor XIIIa and the inhibitors alluded to the probable binding sites of the ligand side chain.

Crk activation of JNK via C3G and R-Ras

v-crk is an oncogene identified originally in CT10 chicken tumor virus. C3G, a guanine nucleotide exchange factor (GEF) for Rap1 and R-Ras, is postulated to transduce the oncogenic signal of v-Crk to c-Jun kinase (JNK). We have found that R-Ras, but not Rap1, mediates JNK activation by v-Crk in 293T and NIH 3T3 cells. Constitutively activated R-Ras, R-Ras(Val-38), but not Rap1(Val-12), activated JNK, as did the constitutively active H-Ras(Val-12) or Rac1(Val-12). v-Crk activation of JNK was inhibited by a dominant-negative mutant of R-Ras, R-Ras(Asn-43). JNK activation by R-Ras(Val-38) was inhibited by a dominant-negative mutant of mixed lineage kinase 3. Among six GEFs for Ras-family G proteins, mSos1, Ras-GRF, C3G, CalDAG-GEFI, Ras-GRP/CalDAG-GEFII, and Epac/cAMP-GEFI, GEFs for either H-Ras or R-Ras activated JNK and c-Jun-dependent transcription. CalDAG-GEFI and Epac/cAMP-GEFI, both of which are GEFs specific for Rap1, did not activate JNK or c-Jun-dependent transcription. These results demonstrate that R-Ras, but not Rap1, is the downstream effector of C3G to stimulate JNK. Finally, we found that expression of the dominant-negative R-Ras mutant induced flat reversion of NIH 3T3 cells transformed by v-Crk, suggesting that R-Ras-dependent JNK activation is critical for the transformation by v-Crk.

An infectious DNA clone of HIV type 1 subtype C

Among the 10 subtypes of the M group of human immunodeficiency virus type 1, subtype C is the most prevalent in India and may dominate worldwide in the near future; however, there has been no report on the infectious DNA clone of this subtype. We have isolated an infectious DNA clone of the 93IN101 strain of HIV-1 subtype C, which was isolated in India in 1993. MAGIC5 cells, which are derived from HeLa-CD4-LTR-beta-gal (MAGI) cells and express CCR5, were inoculated with the 93IN101 strain of HIV-1 subtype C. The genomic DNA of the infected cells was used as a template for amplification of the HIV-1 genome. The genome DNA obtained was subcloned into pBR322, and the resulting plasmid was designated as pIndie-C1. The insert of pIndie-C1 was 9680 bp in length and had an intact genomic organization with open reading frames of all structural, regulatory, and accessory proteins. Phylogenetic analysis confirmed that the nucleotide sequence of pIndie-C1 is closely related to those of HIV-1 subtype C isolated in India. Transfection of pIndie-C1 into 293T cells yielded as much virus as did pNL432, one of the most widely used HIV DNA clones. The recovered Indie-C1 virus infected MAGIC5 but not the parent MAGI cells, indicating that Indie-C1 is CCR5 tropic. Expressed Env protein was reacted efficiently with the sera of HIV-1-infected patients of India, but not of Japan. Expression of Nef and Vpr was also confirmed by immunoblotting.

Total synthesis of a natural antioxidant and structure-activity relationships of related compounds

A total synthesis of benzodioxole derivative 1 was achieved via a palladium(0)-catalyzed cross-coupling reaction in a 68% overall yield (4 steps). A novel series of benzodioxoles bearing a variety of aromatic and heterocyclic rings was also prepared and the antioxidative activity evaluated using in vitro model systems. Structure-activity studies revealed that i) intramolecular hydrogen-bonding in the phenol moiety reduced activity, ii) introduction of disubstituents at the ortho location relative to the phenol increased activity, and iii) the methylenedioxy function contributed to stabilization of the phenoxy radical. Among of these compounds, 5,7-di-(4-methoxyphenyl)-4-methoxy-6-hydroxy-1,3-benzodioxole (7p) was the most favorable agent and more potent than n-propyl gallate.

[Usefulness of 67Ga scintigraphy in deciding surgical indication in secondary hyperparathyroidism]

In order to evaluate the usefulness in deciding surgical indication in secondary hyperparathyroidism (SHP), 67Ga scintigraphy was performed in 37 patients of SHP before parathyroidectomy (PTx). The radionuclide accumulation in skull and submandible was classified into 4 patterns (skull-submandibular pattern, skull pattern, submandibular pattern and normal pattern). Serum alkaline phosphatase levels were significantly elevated in patients of skull-submandibular pattern (13 cases) compared with skull pattern (6 cases), submandibular pattern (6 cases) and normal pattern (12 cases). Serum intact parathyroid hormone levels were significantly elevated in patients of skull-submandibular and skull patterns compared with normal pattern. No significant difference was observed among the weight of resected parathyroid glands. In 4 of 6 patients of normal pattern on 67Ga scintigram, bone scintigraphy showed a characteristic pattern of SHP including an increased accumulation in the skull and submandible. Bone mineral density (BMD) in the distal radius was increased within six to twelve months after PTx in 10 of 11 patients of skull-submandibular pattern on 67Ga scintigram, whereas only one patient showed an increase in BMD in 9 patients of normal pattern. In summary, it was concluded that 67Ga scintigraphy could provide a useful information in deciding the indication for PTx in secondary hyperparathyroidism.

[Chronological study for solitary bone metastasis in the sternum from breast cancer with bone scintigraphy]

Since breast cancer is frequently associated with bone metastasis, bone scintigraphies have been performed to determine pre-operative staging and to survey postoperative bone metastasis. The sternum, in particular, is a site at which is difficult to differentiate between benign bone disease and bone metastasis, because of varied uptake and wide individual variations. In this study, chronological bone images were scintigraphied in six cases with solitary sternal metastasis and three cases with benign bone disease including two fracture cases and one arthritis case. On bone scintigrams in which solitary sternal metastasis appeared, increased uptake was found in five cases, and photon deficiency was observed in one case. During follow-up scintigraphies, abnormal accumulations, such as hot spots and cold lesions, increased in the bone metastasis while abnormal uptake disappeared or was unchanged in the benign bone disease cases. On CT, four cases showed osteolytic change, and one exhibited osteosclerotic change. These findings indicate that sternal metastasis usually shows osteolytic change, even if a hot lesion is recognized on bone scintigraphy. In solitary sternal metastasis, for which early diagnosis is difficult, both an integrated diagnosis using other imaging techniques and chronological bone scintigraphy are important.

[Development of a simple method for the washout correction of 123I-IMP SPECT and its application to a quantitative rCBF method]

We have developed a simple method to correct the washout of tracer from the brain based on the two-compartment model in brain early SPECT using N-isopropyl-p-[123I]iodoamphetamine (123I-IMP). This correction was applied to a new quantitative method of regional cerebral blood flow (rCBF) in combination with the microsphere method by continuous arterial sampling previously reported. Data acquisition of 123I-IMP early SPECT was started from 35 min after 123I-IMP i.v. injection, and the time activity curve of whole brain on anterior head planar images was monitored immediately after 123I-IMP i.v. injection for the correction of washout of tracer from the brain. The usefulness of this method was evaluated in 12 patients with various brain diseases by comparison with the results obtained from the super-early SPECT at 7-10 min after 123I-IMP i.v. injection. The washout rates in cases of early SPECT corrected by this method ranged from 16.91% to 39.34% with a mean +/- SD of 27.72 +/- 5.44%. The contrast of hypo- to hyperperfusion regions on early SPECT was improved by the correction of the washout, and its intracerebral distribution was similar to the simultaneously obtained super-early SPECT images. These results indicated that the present correction method for the washout was useful for more correct quantification of rCBF.

The efficacy of a custom-fabricated nasal mask on gas exchange during nasal intermittent positive pressure ventilation

Commercially available nasal masks have a large mask volume and give rise to considerable air leaks around the mask during nasal intermittent positive pressure ventilation (NIPPV) which may reduce alveolar ventilation (VA per breath). The effects of a custom-fabricated nasal mask (F-mask) versus a commercially available mask (C-mask) on arterial blood gas measurements, dead space including both physiological and apparatus dead space (VD), air leak and VA per breath were compared in patients with restrictive thoracic disease during short-term NIPPV sessions while using a volume cycled ventilator with equivalent settings for both masks. The mask volume of the C-mask was significantly larger than that of the F-mask (p<0.003). The arterial carbon dioxide tension (Pa,CO2) during NIPPV with either the F-mask (5.56+/-1.35 kPa) (mean+/-SD) or the C-mask (6.87+/-0.96 kPa) was significantly lower than during spontaneous breathing (7.75+/-0.81 kPa; p<0.003), but the Pa,CO2 decreased more during NIPPV with the F-mask than with the C-mask (p<0.003). The VD was significantly smaller (p<0.03), the air leak was significantly less (p<0.03), and the VA per breath was significantly larger (p<0.03) during NIPPV with the F-mask than with the C-mask. In conclusion, nasal intermittent positive pressure ventilation with the F-mask was more effective than nasal intermittent positive pressure ventilation with the commercially available mask due to its smaller dead space and less air leak. Further studies are needed to extend these results to all the commercially available-masks.

[Nuclear medicine of bone]

Bone scintigraphy using 99mTc-labeled phosphorous compounds was found to be the most frequently ordered nuclear medicine examination in a nationwide survey in Japan, and has been used for the detection of lesions and the evaluation of disease progression and response to therapy in various skeletal diseases. In this article, we review improvement of the diagnostic sensitivity and specificity for bone metastasis of not only nuclear medicine techniques, such as planar imaging, SPECT, early flow phase imaging and quantification of bone scintigraphy, and bone marrow scintigraphy but also such recently developed methods as bone mineral measurement, and bone metabolic marker assays. In addition, radionuclide therapy of intractable bone pain due to bone metastasis is also addressed.

Interrater reliability of the Japanese version of the Positive and Negative Syndrome Scale and the appraisal of its training effect

The purpose of the present study is to test interrater reliability of the Japanese version of the Positive and Negative Syndrome Scale (PANSS) and to examine factors possibly affecting the reliability. The study group conducted the PANSS rating on 20 patients with DSM-IV schizophrenia. For the analysis of interrater reliability, intraclass correlation coefficient (ICC) was calculated. The ICC for individual items of the PANSS ranged from 0.26 to 0.92, and those for the positive, negative, and general psychopathology subscales were 0.85, 0.83 and 0.75, respectively. The Cronbach's alpha coefficient for the subscales were 0.84, 0.87 and 0.76, respectively. The interrater reliability and the internal consistency were satisfactory and similar to those obtained in the antecedent studies. No salient training effect was found in a sequential analysis of the concordance rate. It is concluded that the Japanese version of the PANSS is a reliable and efficient tool for comprehensive assessment of the schizophrenic syndrome.

Effects of nasal continuous positive airway pressure therapy on respiratory parameters of upper airway patency in patients with obstructive sleep apnea syndrome

OBJECTIVES

To assess whether an initial treatment with nasal continuous positive airway pressure (NCPAP) therapy, applied for one night, had any effect on airway patency.

METHODS

In 18 patients with obstructive sleep apnea syndrome (OSAS), we measured the total resistance of the respiratory system (Rrs) and their relevant lung functions before and after polysomnography, with and without NCPAP therapy. The Rrs was measured at 3 Hz with the forced oscillation technique. The overnight changes in the specific respiratory conductance (SGrs=reciprocal of the Rrs per unit lung volume) was also calculated in the sitting position. Since many reports have suggested that obesity, through fat deposits around the pharynx, can affect the mechanical and neuromuscular properties of the upper airway, we also investigated if the degree of obesity was related to the magnitude of improvement in these parameters.

RESULTS

After the first night of NCPAP therapy, the Rrs decreased (sitting: 4.8+/-0.4 vs 4.3+/-0.4 cm H20/L/s, p < 0.05; lying: 6.5+/-0.4 vs 5.6+/-0.4 cm H20/L/s, p < 0.05) and the maximal voluntary ventilation increased in the morning (sitting: 101.6+/-5.8% vs 106.4+/-4.5%, p < 0.05; lying: 91.2+/-5.4% vs 97.9+/-4.7%, p < 0.05). The overnight difference in the SGrs showed a significant improvement after the initial treatment with NCPAP therapy (p < 0.05). However, the lung volume, flow volume loop, and closing volume in the morning did not change significantly after the therapy. An overnight decrease in the Rrs following NCPAP therapy is significantly correlated with the body mass index (sitting: r=0.54, p < 0.05; lying: r=0.61, p < 0.01).

CONCLUSION

The improvements in Rrs without changes in spirometry may reflect improved upper airway patency after NCPAP therapy. The degree of obesity is suggested to be associated with the treatment effect on upper airway in patients with OSAS.

Improvement of factor VII clotting activity following long-term NCPAP treatment in obstructive sleep apnoea syndrome

Obstructive sleep apnoea syndrome (OSAS) is a very common disorder. Patients with OSAS are at an increased risk for cardiovascular events. It has also been reported that a 25% rise in factor VII clotting activity (FVIIc) is associated with a 55% increase in ischaemic heart disease death during the first 5 years. We examined the effects of nasal continuous positive airway pressure (NCPAP) treatment on FVIIc in patients with OSAS. FVIIc was investigated prospectively in 15 patients with OSAS before (mean +/- SEM apnoea and hypopnoea index (AHI) 61.5 +/- 4.2 and after (AHI 3.0 +/- 0.9) NCPAP treatment for immediate relief, at 1 month after treatment and at over 6 months. FVIIc levels gradually decreased after NCPAP treatment. After 6 months of NCPAP treatment, FVIIc levels had decreased significantly (before 141.1 +/- 11.7% vs. after 6 months 110.7 +/- 6.2%; p < 0.01). Six of the seven patients whose FVIIc levels were over 140% before the NCPAP treatment had FVIIc levels below 130% after 6 months or 1 year of NCPAP treatment. This decrease in FVIIc after long-term NCPAP treatment could improve mortality in OSAS patients. If patients, especially obese ones, present with high FVIIc of unknown origin, it would be prudent to check for OSAS.

The nocturnal secretion of cardiac natriuretic peptides during obstructive sleep apnoea and its response to therapy with nasal continuous positive airway pressure

The nocturnal secretion profile of the newly identified natriuretic peptide (NP), brain natriuretic peptide (BNP), was studied in 14 patients with obstructive sleep apnoea syndrome (OSAS) (apnoea hypopnoea index: 60.5 +/- 3.4, mean +/- SE) during two separate nights before and during nasal continuous positive airway pressure (NCPAP) therapy. Plasma levels of NPs (atrial natriuretic peptides; ANP and BNP) were measured at 2-h intervals during sleep. Simultaneously, blood pressure was measured by a non-invasive method (Finapres, Ohmeda, Englewood, CO, USA) and urine was collected for determining volume and catecholamine levels. Urinary and serum sodium concentration were determined before and after the study. Eight non-snoring subjects were also studied for the investigation of normal nocturnal profiles of BNP levels. To understand the discrete secretion profiles of the two NPs during sleep, blood was sampled from an additional seven patients every 5 min over a 30-min period around 00.00 and 04.00 hours before NCPAP. In patients with OSAS, plasma BNP levels increased from the beginning of sleep (22:00 h) to the morning (06:00 h) before NCPAP therapy (P < 0.01, ANOVA). Baseline BNP levels were not significantly correlated with patient's clinical and polysomnographic parameters. However, in the latter half of the sleep period (02:00-06:00 h), increases in BNP levels during the night before NCPAP therapy were significantly correlated with blood pressure elevations (systolic: r = 0.784 P < 0.01, diastolic: r = 0.587 P < 0.01) and with apnoea duration (r = 0.582 P < 0.01). In normal subjects BP and BNP levels were not changed significantly during sleep. Plasma BNP levels were well correlated with concomitant ANP levels (P < 0.001). NCPAP therapy reduced ANP and BNP levels during sleep and in the morning (P < 0.01). Plasma levels of BNP at 5 min intervals before NCPAP therapy revealed few variations. On the other hand, ANP levels fluctuated over the 30-min period. Changes in BNP levels during sleep in the patients with OSAS may be related to blood pressure variations, but may be too small to play a significant physiological role in regulating diuresis in OSAS. Further work is required to determine the precise role of dual natriuretic system in cardiovascular load and natriuresis in OSAS.

Phosphorylation of CrkII adaptor protein at tyrosine 221 by epidermal growth factor receptor

CrkII adaptor protein becomes tyrosine-phosphorylated upon various types of stimulation. We examined whether tyrosine 221, which has been shown to be phosphorylated by c-Abl, was phosphorylated also by other tyrosine kinases, such as epidermal growth factor (EGF) receptor. For this purpose, we developed an antibody that specifically recognizes Tyr221-phosphorylated CrkII, and we demonstrated that CrkII was phosphorylated on Tyr221 upon EGF stimulation. When NRK cells were stimulated with EGF, the tyrosine-phosphorylated CrkII was detected at the periphery of the cells, where ruffling is prominent, suggesting that signaling to CrkII may be involved in EGF-dependent cytoskeletal reorganization. The EGF-dependent phosphorylation of CrkII was also detected in a c-Abl-deficient cell line. Moreover, recombinant CrkII protein was phosphorylated in vitro by EGF receptor. These results strongly suggest that EGF receptor directly phosphorylates CrkII. Mutational analysis revealed that the src homology 2 domain was essential for the phosphorylation of CrkII by EGF receptor but not by c-Abl, arguing that these kinases phosphorylate CrkII by different phosphorylation mechanisms. Finally, we found that the CrkII protein phosphorylated upon EGF stimulation did not bind to the phosphotyrosine-containing peptide and that CrkII initiated dissociation from EGF receptor within 3 min even with the sustained tyrosine phosphorylation of EGF receptor. This result implicated phosphorylation of Tyr221 in the negative regulation of the src homology 2-mediated binding of CrkII to EGF receptor.

Inhibition of human immunodeficiency virus type 1 virion entry by dominant-negative Hck

To study the role of Src family tyrosine kinases in infection with human immunodeficiency virus type 1 (HIV-1), we constructed an Hck mutant, HckN, that hinders signaling from wild-type Hck. HIV-1 produced in HckN-expressing cells was significantly less infectious to HeLa-CD4-LTR-beta-gal (MAGI) cells than HIV-1 produced in mock-transfected cells. The inhibitory effect of HckN was compensated for by the expression of vesicular stomatitis virus G protein. Finally, we found that the HIV-1 produced in the HckN-expressing cells entered into the cells less efficiently than did the control HIV-1. These results suggest that the Src family tyrosine kinases regulate entry of HIV-1 into target cells.

Morphometric nerve fiber analysis and aging process of the human abducent nerve

Myelinated nerve fibers of the human abducent nerve were analyzed with a new staining method that permits simultaneous observation of the axon and surrounding myelin sheath. The following equipment was employed for the measurements: an image-analyzing digitizer, a microscope equipped with a drawing tube (or camera lucida), and a computer for data storage and statistical analysis. The numbers, transverse areas, and circularity ratios of axons were measured in 10 human abducent nerves. The average number was 1,997 with a definite decrease with age, and the average area was 3.90 micron 2.

Unmyelinated nerve fiber analysis of the human abducent nerve

Unmyelinated nerve fibers of the abducent nerve have occasionally been observed with electron microscopes, but, to our knowledge, they have never been evaluated from the morphometric point of view. We analyzed the aging process of the unmyelinated nerve fibers in the human abducent nerve with the help of a new staining method suitable for morphometric research on the nervous system. We studied numbers and transverse areas of unmyelinated fibers of the abducent nerve in 10 cadavers. Our findings were that (1) these fibers were distributed diffusely, (2) their number decreased with age, and (3) the mean transverse area did not change with age. Most of the unmyelinated axons were thinner than the myelinated axons. These results may be important for analysis of clinical signs in relation to aging and ophthalmologic functions.

Adrenoceptors affect accommodation by modulating cholinergic activity

In an attempt to clarify the functional role of adrenoceptors in accommodation, the effects of various adrenergic agents on the state of accommodation were studied. Fifty-two emmetropic, visually normal subjects (24.6 +/- 0.42 years old) participated in this study. Using an infrared optometer, the far and near points of accommodation were measured by a quasistatic method. Tonic accommodation and accommodative adaptation were also investigated. All these parameters were measured before and after topical application of various adrenergic agents. Both bunazosin hydrochloride (0.1%) and phenylephrine hydrochloride (5%) had no effect on tonic accommodation and accommodative adaptation. However, bunazosin hydrochloride increased the near point of accommodation. Timolol maleate (0.5%) and isoproterenol hydrochloride (3.0%) did not affect tonic accommodation. Isoproterenol hydrochloride evoked a hyperopic shift of the far point of accommodation by 0.23 +/- 0.42 diopters (D). Additionally, accommodative adaptation was increased by timolol maleate (0.36 +/- 0.62 D) and decreased by isoproterenol hydrochloride (0.18 +/- 0.48 D). These results indicate that both alpha and beta adrenoceptors affect accommodation. Activation of alpha adrenoceptors increased the near point of accommodation and activation of beta adrenoceptors decreased accommodative adaptation, which suggests that activation of adrenoceptors may modify parasympathetic activity; hence, affecting the state of accommodation.

Bone mineral measurement in Japan

Various methods for evaluating bone mineral in appendicular, and axial bone or in the whole skeleton have recently become available. As bone mineral is one of the major determinants of bone strength, its exact measurement should be useful for the diagnosis of osteoporosis, as well as for the prediction of fracture risk and monitoring of therapeutical response. The aims of this paper are to review the fundamental performance of bone mineral measurements, the improvements in DXA systems, and the progress in site-specific bone mineral instruments for the radius and calcaneus used in Japan, and to introduce diagnostic criteria for primary osteoporosis, and report on annual rates of bone loss in Japanese females.

Morphometric analyses of axons in the lateral corticospinal tract with ageing process

Morphometric analyses were carried out to reveal a relation between age and axonal changes in the lateral corticospinal tract (LCST) at the L1 level of the human spinal cord. Histological preparations of the spinal cord were made after embedding in celloidin to stain with Luxol fast blue-periodic acid-Schiff-hematoxylin or Klüver-Barrera methods. The number, average transverse area, total area and diameter of axons of the LCST were counted and measured using an image-analyser combined with a computer. The morphometric analyses revealed that (1) there was a significant decrease in the axonal number of the LCST with age (p < 0.001); (2) the axons were not partially nor completely accompanied by surrounding myelin sheaths, and increased in number with age; (3) the diameter and average area of axons in the LCST became significantly reduced with age (p < 0.01); (4) the total area decreased significantly with age in a unit area of 2,700 microns2; and (5) the circularity ratio showed no significant change with age.

Ventilatory support during exercise in patients with pulmonary tuberculosis sequelae

STUDY OBJECTIVE

The aim of this study was to determine whether intermittent positive pressure ventilation through a nasal mask (NIPPV) applied during exercise in patients with pulmonary tuberculosis sequelae (PTS) could improve arterial blood gas measurements, ameliorate breathlessness, and increase exercise endurance.

PATIENTS

Seven PTS patients with a severe restrictive ventilatory defect (mean [SD] vital capacity, 1.02 [0.25] I) enrolled in this study had experienced NIPPV previously, and were familiar with the procedure.

DESIGN

The patients underwent four constant-load cycle ergometer tests in the supine position to tolerance. The tests were performed with and without NIPPV, while breathing normoxic air (Air) or supplemental oxygen (O2; 35%). NIPPV was delivered during exercise in a controlled, volume-cycled mechanical ventilation mode, and the ventilator settings were modulated manually to meet patients' respiratory demands as estimated from the airway pressure waveform and the patient's breathlessness.

RESULTS

All patients matched their breathing to the ventilator cycle during most of the exercise while receiving NIPPV. NIPPV significantly prolonged their exercise endurance time, from a mean (SD) of 180 (58) s to 310 (96) s in Air, and from 227 (64) s to 465 (201) s in O2. During exercise, NIPPV effectively decreased their breathlessness and significantly improved arterial blood gas measurements.

CONCLUSIONS

NIPPV applied during exercise can effectively support ventilation, significantly ameliorate breathlessness, and consequently improve exercise endurance in patients with PTS.

[Comparative study on the tumor accumulation of 99mTc-tetrofosmin and 99mTc-MIBI in rabbits bearing VX-2 cancer]

Each of myocardial blood flow imaging agents has a potential usefulness as an agent for tumor scintigraphy. The tumor accumulation and washout of 99mTc-tetrofosmin and 99mTc-MIBI were comparatively studied using rabbits bearing VX-2 cancer. From seventeen to twenty days after the implantation of VX-2 cancer into the femoral region of seven rabbits, tumor to soft tissue accumulation ratio (T/S ratio) of each agent was calculated in early images (5 min after injection) and in late images (50 min after injection). Compared with 99mTc-tetrofosmin, the T/S ratio of 99mTc-MIBI was higher and, moreover, the washout was delayed. These results suggest that there is a difference in tumor accumulation property between these two agents.

Myelinated nerve fibre analysis of the human small splanchnic nerve

The aim of the present study is to analyse nerve fibres of the human small splanchnic nerve in relation to the ageing process. The analysis was conducted with the use of a new staining method that makes it possible to discriminate various structures of the nervous tissue. An image-analysing digitiser, a microscope with a drawing tube and a personal computer for storing data and performing statistical analyses were employed in this study. We examined 30 human small splanchnic nerves which were taken from cadaver specimens (20 males and 10 females) aged from 44 to 96 years. Our report may provide a first information concerning the ageing process of the human small splanchnic nerve. The results indicate that a decrease in transverse area and perimeter of myelinated axons in one of the important changes occurring in the human small splanchnic nerve with the ageing process.

Hypoxic ventilatory response and breathlessness following hypocapnic and isocapnic hyperventilation

STUDY OBJECTIVES

To investigate the etiology of posthyperventilation (post-HV) hypoxemia following voluntary hyperventilation (VHV), we examined the effects of hypocapnic (hypo-CO2) and isocapnic (iso-CO2) VHV on the hypoxic ventilatory response (O2-response) and on the sensation of breathlessness during the O2-response.

METHODS

O2-responses and visual analog scale (VAS) scores for estimating breathlessness in 10 normal subjects during the O2-response under iso-CO2 conditions and under hypo-CO2 conditions immediately following voluntary maximal HV of 3 min duration were examined.

RESULTS

Although there was no significant difference in the post-HV ventilation levels following hypo-CO2 vs iso-CO2 VHV, the VAS scores at the start of the O2-response following hypo-CO2 VHV (30.2+/-24.2 mm) were significantly higher (p<0.05) than the VAS scores at the start of the O2-response following iso-CO2 VHV (13.7+/-8.4 mm). However, VHV did not have a significant effect on the O2-response at 2 min after the VHV when the arterial O2 saturation (SaO2) was below 90%. The nonsteady-state hypo-CO2 induced by VHV greatly attenuated the O2-response below 90% SaO2 and VAS scores at 70% SaO2.

CONCLUSIONS

Elevated VAS scores immediately following the hypo-CO2 VHV, which might be independent of actual breathing levels, and the attenuation of the O2-response following the hypo-CO2 VHV were not due to input from lung and chest wall mechanoreceptors induced by the hyperpnea itself, but rather to the hypo-CO2 induced by hyperpnea.

[Evaluation of clinical utility of 111In-DTPA-IgG scintigraphy in the detection of inflammation/infection--a report of multicenter phase III clinical trials]

This is the report of phase III study to evaluate the safety and utility of 111In-DTPA-IgG in patients with strongly suspected inflammation/infection. One hundred and forty five patients with suspected sites of inflammation/infection were enrolled in the study. Only a few adverse experiences in one patient were reported, which were interpreted as having a possible relationship to the agent. A total of 171 suspected sites (12 in head and neck, 39 in thorax, 44 in abdomen and pelvis, 62 in musculoskeletal system, and 14 in other regions) were evaluated by investigators at each institute. Out of 171 sites, 18 were determined to be unevaluable, and 12 false negative and 5 false positive cases were observed. Overall sensitivity and specificity was 89.8% and 85.7%, respectively, and the agent proved to be effective in detecting lesions anywhere throughout the body. The analysis of data from this Phase III study indicates that 111In-DTPA-IgG is well-tolerated in patients and effective in determining focal sites of inflammation/infection although the physiological accumulation in some tissues such as the sinus or liver and possible excretion into the gastrointestinal tract may make it difficult to localize lesions.

[Compartment analysis of 123I-iomazenil brain on early and delayed SPECT]

We investigated the characteristics of 123I-Iomazenil (IMZ) SPECT images in 12 adults (six males and six females, with a mean age of 56.1 years). The washout rate of 123I-IMZ from the brain was estimated from two SPECTs done 15 min and 3 hr after injection. Although the washout was relatively slow, the rates differed in each intracerebral region, suggesting that the distribution of 123I-IMZ was gradually changing. Furthermore, assuming 123I-IMZ kinetics in the brain for the three-compartment, two-parameter model, the transition rate constant (K1) from the blood to the brain and the binding potentials (BP) of benzodiazepine to the receptor were calculated. The BP and K1 values were compared with 123I-IMZ SPECT counts and CBF values by 123I-IMP. The BP values correlated more closely with the counts on the delayed SPECT than those on the early SPECT. It was confirmed that delayed SPECT images reflect better the distribution of the benzodiazepine receptor than early images do. On the other hand, the K1 values correlated highly with CBF obtained by 123I-IMP, and this finding suggested that super-early SPECT images might be remarkably influenced by the distribution of CBF.

Ultrastructural localization of CD38 immunoreactivity in rat brain

The subcellular localization of CD38 in the rat cerebral and cerebellar cortices was studied using immunoelectron microscopy. In the cerebral cortex, immunoreactivity was present in a subset of pyramidal neurons, and was distributed predominantly in the perikarya and dendrites. It was found in association with rough endoplasmic reticulum, ribosomes, small vesicles, mitochondria and the plasma membrane including the postsynaptic densities. In the cerebellum, labeling was observed in several types of neuron such as granule, Golgi, basket and Purkinje cells. In contrast to the cerebrum, immunoreactivity was accentuated in the perikarya or axon terminals, and the synaptic vesicles represented another organelle that was immunopositive for CD38. In both of these CNS regions, the nuclear envelope, particularly the outer membrane, showed constant labeling. Diffuse immunoreactivity was also present in the astrocytes from the perikarya to the processes including the perivascular glia limitans. Oligodendrocytes and microglia were immunonegative for CD38. The pattern of distribution of CD38 in the CNS is suggestive of multiple roles for this molecule at various functional sites in both neurons and astrocytes.

[Effects of topical application of adrenergic agents on refraction and accommodation]

In an attempt to clarify the functional role of adrenergic receptors on accommodation, effects of various adrenergic agents on the state of accommodation were studied. Fifty-two emmetropic normal subjects (age: 19-28 y) participated in this study. We examined the effect of the alpha agonist phenylephrine hydrochloride (5%), the alpha 1 antagonist adrenergic bunazosin hydrochloride (0.1%), the beta antagonist timolol maleate (0.5%), the beta 2 antagonist betaxolal hydrochloride (0.5%), and the beta agonist isoproterenol hydrochloride (3%). Using an infrared optometer, the refraction, far point and near point of accommodation, resting point of accommodation (empty-field accommodation and dark focus of accommodation), and accommodative adaptation were measured before and after topical application of various adrenergic agents. Application of bunazosin slightly but significantly decreased the near point of accommodation. Isoproterenol evoked a hyperopic shift on the far point of accommodation. None of the agents had any effect on the resting point of accommodation. Accommodative adaptation was increased by timolol and betaxolol, and decreased by isoproterenol. We surmised that beta adrenergic agents exerted an indirect influence on the parasympathetic nervous system. The activation of beta receptors produced a hyperopic shift on the far point of accommodation and decreased accommodative adaptation, which suggests that activation of adrenergic receptors may reduce parasympathetic activity, hence affecting the state of accommodation.

Heat shock protein 72 level decreases during sleep in patients with obstructive sleep apnea syndrome

Patients with obstructive sleep apnea syndrome (OSAS) suffer from stresses related to repetitive apneas during sleep. To examine whether the level of 72 kDa heat shock protein (HSP72) increases during sleep, 11 OSAS patients (apnea-hypopnea index: 63.5 +/- 36.1, mean +/- SD) underwent polysomnography and their peripheral blood mononuclear cells (PBMC) were isolated before, during, and after sleep. HSP72 level was determined by Western blotting and hsp72 mRNA level was quantified by Northern blotting. Nine normal subjects without OSAS were examined as normal controls. HSP72 level decreased progressively during sleep and its level at 8:00 A.M. was 78.0 +/- 17.5% of that at 8:00 P.M. (p < 0.01). No such decrease was seen in normal subjects. When OSAS patients received nasal continuous positive airway pressure (NCPAP) therapy, HSP72 level did not decrease significantly. In untreated OSAS patients, hsp72 mRNA level decreased during sleep (p < 0.01). When OSAS patients were treated with NCPAP therapy, the decrease in hsp72 mRNA level was not observed. HSP72 level before sleep in OSAS patients was higher than that in normal subjects (p < 0.01). We concluded that repetitive apneas caused high HSP72 level before sleep in OSAS patients and that NCPAP therapy had significant effect on HSP72 levels during sleep.

Assessment of cardiac sympathetic function with iodine-123-MIBG imaging in obstructive sleep apnea syndrome

Iodine-123-MIBG imaging has been used to evaluate myocardial sympathetic function in various cardiac diseases. In patients with obstructive sleep apnea syndrome (OSAS), increased sympathetic activity has been widely recognized, as assessed by measuring the plasma concentration and urinary excretion of catecholamines and by measuring muscle sympathetic nerve activity. However, these measurements are not specific indices of cardiac sympathetic function. Therefore, this study was undertaken to assess cardiac sympathetic function in patients with OSAS using MIBG cardiac scintigraphy.

METHODS

This study consisted of 11 patients (10 men, 1 woman; mean age 43 +/- 16 yr) with a diagnosis of OSAS established by polysomnography, and 8 age-matched normal control subjects (7 men, 1 woman; mean age 45 +/- 18 yr). Early (15 min) and delayed (3 hr) planar images were taken after the injection of 111 MBq of [123I]MIBG. The mean counts of the whole heart and the mediastinum were obtained to calculate heart-to-mediastinum count ratios from the early images (H/Me) and from the delayed images (H/Md) and the myocardial washout rate (WR). Eight patients were restudied after 1 mo of nasal continuous positive airway pressure treatment.

RESULTS

The H/Me and H/Md ratios were significantly lower in the patients than in the control subjects (H/Me, 2.49 +/- 0.32 versus 2.84 +/- 0.34, p = 0.0207; and H/Md, 2.33 +/- 0.30 versus 3.02 +/- 0.36, p = 0.0013). The WR was higher in the patients than in the control subjects (36.2 +/- 9.0% versus 23.6 +/- 4.9%, p = 0.0022). The H/Me and H/Md ratios in the patients were significantly correlated with the apnea-hypopnea index and the degree of hypoxemia during sleep. After treatment, H/Me and H/Md remained unchanged, but WR significantly recovered (from 34.9 +/- 10.4% to 26.3 +/- 7.7%, p = 0.0357).

CONCLUSION

Cardiac sympathetic function and integrity are impaired in subjects with OSAS when compared with age-matched control subjects. MIBG cardiac imaging can be helpful in evaluating cardiac involvement and efficacy of therapy in OSAS.