Local fungus-specific Immunoglobulin E production in chronic rhinosinusitis with nasal polyps

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease, and its pathogenesis remains controversial. This study aimed to examine the involvement of fungi in CRSwNP pathogenesis.

METHODS

We enrolled 29 controls and 111 CRSwNP patients. We analyzed fungi in the nasal secretions, serum fungus-specific immunoglobulin E (IgE) levels, and nasal polyp (NP) IgE levels. Moreover, we evaluated the correlation between patients' IgE levels and computed tomography (CT) scores.

RESULTS

There was no difference in fungal detection rate between CRSwNP patients with and without asthma. Specific IgEs against various antigens were highly detectable in NPs of CRSwNP patients. In CRSwNP patients, fungus-specific IgE levels in NPs were correlated with CT scores. Serum fungus-specific IgEs became undetectable after operation in more than half of the CRSwNP patients without asthma but not in those with asthma. Other serum airborne antigen-specific IgEs did not become undetectable after operation.

CONCLUSIONS

Fungus-specific IgEs were highly detectable in NPs of CRSwNP patients, and NPs comprised a major region of specific IgE production. Fungi may therefore play an important role in CRSwNP pathogenesis by inducing Th2 immune responses, including IgE synthesis.

[Three cases of Mycobacterium kansasii pulmonary diseases in previously healthy young women]

Mycobacterium kansasii pulmonary diseases account for 20% of cases of non-tuberculous mycobacteria. Most patients are male. However, a recent study has found that radiological examinations in female patients often reveal nodular, bronchiectatic opacities. We describe 3 young women with cavitary opacities. Patient 1 was a 35-year-old woman in whom thin-walled cavitary opacities were detected in the upper lobe during a routine checkup. Sputum examination and fiberoptic bronchoscopy led to a diagnosis of M. kansasii pulmonary disease. Patient 2 was a 23-year-old woman who presented with hemoptysis. Thin-walled cavitary opacities were detected in the right upper lobe. Infection with M. kansasii was diagnosed after a sputum examination. Patient 3 was a 43-year-old woman in whom thin-walled cavitary opacities were detected in the left upper lobe during a routine checkup. Infection with M. kansasii was diagnosed after a fiberoptic bronchoscopic examination. Patient 1 was successfully treated with rifampicin, ethambutol, and levofloxacin, and patients 2 and 3 were successfully treated with isoniazid, rifampicin, and ethambutol. The possibility of M. kansasii pulmonary diseases should be considered in a previously healthy young woman with thin-walled cavitary opacities in the upper lobe.

Abstract 1207: Transactivation of EGFR/ErbB2 receptor by TNF abrogates TNF-induced apoptosis in bronchial epithelial cells and non-small cell lung cancer cells

[Background] Epidermal Growth Factor Receptor (EGFR) and other ErbB receptors; ErbB2-4, through cytokine and growth factor stimulation, are upregulated in pneumonitis and lung cancer, suggesting that the activation of ErbB receptors is response to pneumonitis and lung cancer in humans. TNF is a cytokine with many biological properties including both anti- and pro-apoptotic signaling pathways. However, the molecular switch, which determines TNF regulation of these two different functions is not well characterized. We previously presented that TNF transactivated both EGFR and ErbB2 via Src kinase activity that promote the survival response to TNF. In the present study, we tested the hypothesis that EGFR/ErbBs activity regulates TNF-mediated bronchial epithelial and non-small cell lung cancer cell survival.

[Method] Bronchial epithelial, Beas-2B cells and non-small cell lung cancer, NCI-H292 cells were used for these studies. Cells were treated with TNF (100 ng/ml) in the presence of either PI 3-kinase inhibitor (wortmannin or LY294002), MAP kinase inhibitor (U0126), MMP inhibitor (GM6001 or TAPI-1 or −2) or EGFR tyrosine kinase inhibitor (Erlotinib). Apoptosis and signal transduction pathway activation were determined by TUNEL staining and Western blot analysis, respectively.

[Results] In Beas-2B and NCI-H292 cells, TNF-induced apoptosis was significantly enhanced in the presence of EGFR tyrosine kinase inhibitor. Similarly, treatment of Beas-2B and NCI-H292 cells with TNF failed to increase apoptosis except in the presence of PI 3-kinase inhibitor, which increased the apoptotic response 10-fold. Treatment with TNF in the presence of MAP kinase inhibitor, did not increase apoptosis. In Beas 2B and NCI-H292 cells, TNF stimulated EGFR/ErbB2 phosphorylation within 5 min. EGFR/ErbB2 transactivation by TNF was blocked with GM6001 and TAPI-1, which inhibited MMP activity, especially TACE. Furthermore, in the presence of neutralizing antibodies for HB-EGF, TGF-α and EGF, EGFR/ErbB2 transactivation by TNF was inhibited, suggesting TNF-stimulated EGFR/ErbB2 transactivation via TACE cleavage of HB-EGF, TGF- α and EGF abrogates TNF-induced apoptosis in human bronchial epithelial cell and lung cancer cell. TNF stimulated AKT activation via EGFR tyrosine kinase activation. Akt was shown to be a downstream target of TNF-activated EGFR/ErbB2.

[Conclusion] We demonstrate that TNF stimulates EGFR/ErbB2 transactivation via ADAM/MMP in a manner that requires HB-EGF, TGF- α and EGF with AKT as a critical downstream regulator of TNF-induced anti-apoptosis. This novel observation has significant implications for understanding the role of EGFR/ErbB2 in maintaining human bronchial epithelial cell homeostasis in an environment of inflammation, injury/repair, such as inflammation-associated carcinogenesis and tumor progression.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1207.

Maturational changes in skin color of Japanese newborn infants

BACKGROUND/OBJECTIVE

The skin color of newborn infants is subjectively observed to change, depending upon their gestational age. We evaluated the relationship between neonatal skin color and gestational age by employing an objective method.

METHODS

Using a tristimulus photocolorimeter, L*, a*, and b* were examined as the parameters of skin color in Japanese newborn infants (Commission Internationale de l'Eclairage L*a*b* color space). The following items were examined: (1) the reproducibility of the measurements; (2) the time course of the values during the first 24 h after birth, and (3) the relationship with the gestational age. The gestational age of these infants had been determined by measuring their crown-rump length during fetal periods.

RESULTS

Reliability and validity of the measurements were satisfactory for all parameters. However, a* and b* fluctuated widely during the first 24 h. By contrast, L* was stable between 3 and 24 h after birth. L* measured during these periods directly correlated with the gestational age (r=0.843, p<0.0001).

CONCLUSIONS

Because L* represents lightness or darkness, our results suggest that the skin color changes from black to white with maturation. L* may be a helpful parameter for the evaluation of the gestational age of newborn infants.

Improvement in electrical properties of hafnium and zirconium silicates by postnitriding

Hafnium and zirconium silicate films were deposited on a silicon substrate and the effects of postannealing on their electrical properties were investigated. When the films are postannealed in nitrogen monoxide (NO), the leakage current becomes lower by more than one order of magnitude as compared with that of the as-deposited films. The capacitance-voltage (C-V) hysteresis width is also decreased drastically by the NO postannealing. From electron spin resonance spectroscopy, it is indicated that paramagnetic defects at the interface between the film and the substrate are responsible for the leakage current and the C-V hysteresis. It is also indicated by x-ray photoelectron spectroscopy that the postnitridation effectively terminates these interface defects and contributes to the improvement in electrical properties.

The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT): initial aims and impact of the family history of type 1 diabetes mellitus in Japanese children

The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT) was established in July 1994 with the chief aim to improve the quality of therapy for type 1 diabetes in children, an entity far less common in Japan than in Europe. We proposed four initial research topics: (i) to determine the current status of medical care and glycemic control in Japanese children with type 1 diabetes mellitus; (ii) to standardize the measurement of hemoglobin A1c; (iii) to establish a registry of a large cohort of patients in order to enable prospective studies to improve the quality of therapy for children with type 1 diabetes in Japan; and (iv) to enable participants of the JSGIT to hold a workshop twice annually. We registered a total of 736 patients from 45 hospitals throughout Japan. Intervention via insulin treatment was instituted after 2 yr for those patients whose hemoglobin A1c level was more than 8.1%. The proportion of patients receiving multiple insulin injections increased after intervention; however, average hemoglobin A1c in females remained significantly higher than in males. We identified two forms of diabetes in Japanese children: a rapidly progressive form and a more slowly progressive form. There was a significantly higher prevalence of a family history of diabetes in first-degree relatives in the slowly progressive form. These preliminary findings are the result of the first collaborative study of childhood diabetes in Japan.

[The relation between the severity of bronchial asthma and the treatment points in children]

The treatment points and score for definition of the asthma severity were initially introduced in the guideline for pediatric asthma treatment and management on 1998. We studied the relationship between the severity of clinical symptoms for children with bronchial asthma and the treatment points from July 1998 to November 1999 in our hospital. One hundred twenty five patients (one to 15 years of age, 77 boys and 48 girls) were retrospectively investigated. The treatment points and scores were associated with the clinical symptom score. However, there was no relationship in some patients. In order to define the severity of bronchial asthma, we should investigate not only the severity in terms of the clinical symptoms; the number and degree of asthma attacks, but also the treatment points and score. Furthermore, we should pay attention to the seasonal variation of the treatment points.

Self-splicing of the Tetrahymena group I ribozyme without conserved base-triples

BACKGROUND

Group I introns share a conserved core region consisting of two domains, P8-P3-P7 and P4-P6, joined by four base-triples. We showed previously that the T4 td intron can perform phosphoester transfer reactions at two splice sites in the absence of both P4-P6 and the conserved base-triples, whereas it is barely able to perform the intact splicing reaction due to the difficulty of conducting the sequential reactions.

RESULTS

Based on previous findings, we constructed a bimolecular ribozyme lacking a large portion of P4-P6 and the base-triples from the Tetrahymena intron, on the assumption that the long-range interactions of the peripheral regions in the two RNAs can compensate for the deteriorated core. The bimolecular ribozyme performed the intact splicing reaction.

CONCLUSION

The present analysis indicates that the base-triples are nonessential, but that L4 and the distal part of P4 in P4-P6 are important for conducting the splicing reaction. The reconstituted self-splicing ribozyme provides an amenable system for analysing the role(s) of elements in the core region in the self-splicing reaction mechanism.

A deteriorated triple-helical scaffold accelerates formation of the Tetrahymena ribozyme active structure

The Tetrahymena group I ribozyme requires a hierarchical folding process to form its correct three-dimensional structure. Ribozyme activity depends on the catalytic core consisting of two domains, P4-P6 and P3-P7, connected by a triple-helical scaffold. The folding proceeds in the following order: (i) fast folding of the P4-P6 domain, (ii) slow folding of the P3-P7 domain, and (iii) structure rearrangement to form the active ribozyme structure. The third step is believed to directly determine the conformation of the active catalytic domain, but as yet the precise mechanisms remain to be elucidated. To investigate the folding kinetics of this step, we analyzed mutant ribozymes having base substitution(s) in the triple-helical scaffold and found that disruption of the scaffold at A105G results in modest slowing of the P3-P7 folding (1.9-fold) and acceleration of step (iii) by 5.9-fold. These results suggest that disruption or destabilization of the scaffold is a normal component in the formation process of the active structure of the wild type ribozyme.

Elevated type IV collagen in bronchoalveolar lavage fluid from infants with bronchopulmonary dysplasia

We measured the levels of type IV collagen and lipid peroxides in bronchoalveolar lavage fluid (BALF) from infants with respiratory distress syndrome (RDS) to determine the relationship to the development of bronchopulmonary dysplasia (BPD). We analyzed their levels between two groups, RDS infants who developed BPD (n = 8, BPD group) and those who did not (n = 11, RDS group). The levels of the type IV collagen in the BPD group were significantly higher than those in the RDS group at 3 and 7 days of age (p = 0.0024). In the BPD group, persistently increased levels of the type IV collagen were observed during the period up to 14 days of age. There was a positive relationship between the type IV collagen levels and polymorphonuclear leukocyte counts, and thiobarbituric acid-reactive substance levels in BALF. These results suggest that the increased type IV collagen levels in BALF of BPD infants may reflect pulmonary basement membrane damage and the involvement of oxygen metabolites in its process.

Ultrasonographic detection of very thin percutaneous central venous catheter in neonates

To assess the ability of ultrasonography to detect the tip of a very thin (0.4 mm outer diameter) percutaneous central venous catheter (PCVC) in neonates, the PCVC tip location was assessed by ultrasonography (US) and compared to the location estimated by standard radiography for 57 PCVCs in 44 neonates. Of 57 occasions, the examiner could not find the PCVC tip in three cases (5%). In the remaining 54 instances, in 87% of cases, the PCVC tip position was consistent with the location implied by skeletal landmarks on standard radiographs. On 24 occasions we also assessed catheter tip dislodgement according to flexion and extension of the infant's arm. US could detect 78% of cases of catheter tip dislodgement. The PCVC tip was sometimes visualized as a dot and parallel lines as well as mere parallel lines. In a large population of cases, US is a reliable method for detection of a thin PCVC tip. US provides precise information about the PCVC tip position in relation to vascular structure and contributes to safer positioning of the PCVC than traditional radiography alone.

Fabrication of long-period optical fiber gratings by use of ion implantation

We report the fabrication of long-period optical fiber gratings by use of a refractive-index increase induced by ion implantation. Helium ions were implanted in an optical fiber core through a metal mask that had a 170-microm -pitch grating with spacing of 60 microm . We obtained a wavelength-dependent effective transmission loss by use of the grating.

Disynaptic pyramidal excitation in forelimb motoneurons mediated via C(3)-C(4) propriospinal neurons in the Macaca fuscata

In contrast to findings in the cat, it recently has been shown that disynaptic pyramidal EPSPs only rarely are observed in forelimb motoneurons of the macaque monkey in the intact spinal cord or after a corticospinal transection in C(5). This finding has been taken to indicate that the disynaptic pyramidal excitatory pathway via C(3)-C(4) propriospinal neurons (PNs) is weakened through phylogeny when the monosynaptic cortico-motoneuronal connection has been strengthened. We reinvestigate this issue with special focus on the possibility that the inhibitory control of the C(3)-C(4) PNs may be stronger in the macaque monkey than in the cat. The effect in forelimb motoneurons of electrical stimulation in the contralateral pyramid was investigated in anesthetized macaque monkeys (Macaca fuscata). We confirmed the low frequency of disynaptic pyramidal EPSPs in forelimb motoneurons. However, after intravenous injection of strychnine, disynaptic EPSPs could be evoked in 39 of 41 forelimb motoneurons recorded after lesion of the corticospinal fibers in C5. After a corresponding lesion in C(2), disynaptic pyramidal EPSPs were observed in 2 of 25 motoneurons. In contrast to previous reports, we conclude that C(3)-C(4) PNs can mediate disynaptic pyramidal excitation in high frequency of occurrence to forelimb motoneurons in the C(6)-C(8) segments and that this transmission is under a stronger inhibitory control than in the cat. Thus, the hypothesis that the disynaptic excitatory cortico-motoneuronal pathway via the C(3)-C(4) PNs is weakened in parallel with the strengthened monosynaptic connection through phylogeny is not supported by the present findings.

Transtubular potassium concentration gradient in preterm neonates

To determine the postnatal changes in mineralocorticoid action on the cortical distal nephron in preterm neonates, we evaluated the transtubular potassium gradient (TTKG) and its relationship to other renal and non-renal parameters in 16 preterm neonates during the first 5 weeks of life. Preterm neonates were divided into two groups according to their gestational age: the first group (group A, n=9) had a gestational age less than 30 weeks and the second group (group B, n=7) had a gestational age over 30 weeks. TTKG in both groups increased significantly with postnatal age, and TTKG in group A was significantly lower than that in group B (P=0.0003; two-way repeated analysis of variance). TTKG in group A was significantly lower during the 2 weeks of postnatal life than that in full-term neonates [TTKG during 1st week (mean+/-SD) 3.73+/-1.32, P<0.00001; during 2nd week 7.77+/-3.60, P=0.0096 versus full-term neonates (n=19); 11.56+/-3.23]. TTKG in group B was significantly lower only during the 1st week of life (6.55+/-2.71, P=0.0013) compared with full-term neonates. Plasma aldosterone concentration did not correlate with TTKG value. Stepwise regression analysis showed that postnatal age, cortical lumen sodium concentration (CLNa), and clinical condition requiring the use of mechanical ventilation were independent variables that correlated significantly with TTKG. We postulate that the low TTKG level in preterm neonates might reflect the prematurity of renal function (early postnatal age, CLNa) and the condition(s), relating to immaturity, such as the use of mechanical ventilation.

Bronchial reactivity to inhaled methacholine in infants with asthma and age-matched controls

To evaluate bronchial hyperresponsiveness (BHR) in infants with asthma and the influence of aging on BHR during the infantile period, bronchial reactivity to inhaled methacholine (BRm) in infants was monitored using the transcutaneous oxygen pressure (tcPO2) method. One hundred thirty-seven infants with asthma (from 1 to 5 years, mean 3.4 years) and 97 age-matched children without chronic respiratory diseases (from 6 months to 5 years, mean 2.1 years) were enrolled in this study. Consecutive doses of methacholine were doubled until a 10% decrease in tcPO2 from the baseline was reached. The cumulative dose of methacholine at the inflection point of tcPO2 (Dmin-PO2) was considered to represent the reactivity of tcPO2 to inhaled methacholine. Dmin-PO2 values in the asthma groups were lower than those in the control groups in each year-group from 1 to 5. There was no statistical difference in Dmin-PO2 among the 1-4-year-old asthma groups, but Dmin-PO2 in the 5-year-old asthma group was significantly lower than Dmin-PO2 in the 1-4-year-old asthma groups. The same age-related change in Dmin-PO2 was also seen in the control groups. There was no difference in age-related Dmin-PO2 change between the female group and the male group. We concluded that BRm in asthmatic children increases during the infantile period, and that the age-related changes in BRm, observed in both asthmatic and control infants, may have an effect on the clinical symptoms of asthma during childhood.

Sensorimotor interactions between pairs of fingers in bimanual and unimanual manipulative tasks

The tuning of fingertip forces to the physical properties of objects during manipulation may be controlled partly by digit-specific mechanisms using local afferent information and partly by controllers that support interdigital coordination and use sensory information from more than one digit. In the present study we addressed digital interactions when humans used the tips of two fingers to restrain a pair of horizontally oriented plates from moving when subjected to tangential force loads in the distal direction. Subjects used the right and left index fingers in a bimanual grasp, and the right index and middle fingers in an unimanual grasp. The plates were loaded at unpredictable times by identical force profiles consisting of a force increase of up to a 3-N force plateau. The plates were concurrently loaded in 85% of the trials and each plate was loaded separately in 7% of the trials. For each plate, we measured its movement and the normal and tangential forces applied by the finger to restrain it. When a finger was loaded, the subject automatically responded by a normal force increase to a level that remained fairly constant during the subsequent load plateau. The initial part of this finger grasp response was affected by simultaneous loading of its partner finger; the magnitude of the response was boosted with a bimanual grasp, whereas the onset latency tended to be shorter with a unimanual grasp. Responses also occurred at a non-loaded finger during both bimanual and unimanual grasps, but these responses were weaker than those evoked when the same finger was loaded. In the bimanual grasp, they were largely characterized by a brief force pulse whose onset was delayed by some 15 ms compared with the response onset of the loaded finger, i.e., there was no sustained response. In the unimanual grasp, the onset of the response coincided in time with that of the accompanying (loaded) finger, and the dynamic response was stronger and prolonged, with more than one force rate peak. There was also a significant static response present. We conclude that during unimanual as well as bimanual reactive restrain tasks there are interactions between digits engaged in terms of neural control that facilitate the response of a digit when an accompanying digit is simultaneously loaded. However, digit-specific afferent inputs are necessary for eliciting the full-size reactive grasp responses required to successfully restrain the manipulandum.

Effect of ultrasonically nebulized distilled water on airway epithelial cell swelling in guinea pigs

To investigate the pathogenesis of ultrasonically nebulized distilled water-induced airway narrowing, we studied the role of airway epithelial cells during a distilled water-inhalation challenge in an animal model of airway inflammation. Guinea pigs were divided into four groups: 1) a sham/saline (S/S) group: sham ozone followed by saline inhalation; 2) a sham/water (S/W) group: sham ozone followed by water inhalation; 3) an ozone/saline (O/S) group: ozone followed by saline inhalation; and 4) an ozone/water (O/W) group: ozone followed by water inhalation. After exposure to either 3.0 parts/million ozone or air at the same flow rate for 2 h, guinea pigs were anesthetized and tracheostomized, and then lung resistance (RL) was measured. For morphometric assessment, tissues were fixed with formaldehyde, stained with hematoxylin and eosin, and cut into transverse sections. Airway dimensions were either measured directly or calculated from the internal perimeter, the external perimeter, and airway wall area. There were no statistical differences in the values of RL before distilled water inhalation between the sham groups and the ozone groups. RL increased significantly after 10 min of distilled water inhalation in both the S/W group and the O/W group. In the S/W group, epithelial cells were swollen, and intercellular spaces were wider, resulting in significant increase in epithelial wall thickness, but there was no significant infiltration by inflammatory cells. In the O/S group, the epithelium showed infiltration by inflammatory cells without change in cell volume. In the O/W group, the epithelium showed both infiltration and a greater increase in epithelial wall thickness compared with the S/W group. These results suggest that airway epithelial cell swelling, induced by inhaled distilled water, increases with RL in guinea pigs and that this reaction may be accelerated by airway inflammation.

Transcutaneous oxygen tension measurements during methacholine challenge of prematurity in infants with chronic lung disease

Chronic lung disease (CLD) of prematurity may be caused by a number of insults during mechanical ventilation, including barotrauma and hyperoxia. To evaluate bronchial hyperresponsiveness (BHR) in infants with CLD of prematurity, we measured changes in transcutaneous oxygen tensions (tcPO2) during methacholine inhalation challenge. Twelve infants with CLD and 22 age-matched children without respiratory diseases were enrolled in this study (ages--5 to 36 months; mean age--16.2 months). Serial doses of methacholine were doubled until a 10% decrease in tcPO2 from baseline was reached. The cumulative dose of methacholine inhaled by the time tcPO2 had been reached (Dmin-PO2) was considered to represent the dose at which reactivity to methacholine (RO2meth) had occurred. In the CLD group, Dmin-PO2 (3.50 +/- 0.1 log x milli-units) was significantly lower than in the preterm control infant group (4.31 +/- 0.2 log x milli-units) and the term infant group (4.21 +/- 0.1 log x milli-units) (P = 0.004, P < 0.001). Dmin-PO2 in the preterm control infant group was not significantly different than in the term infant group (P > 0.5). These results suggest that infants who require additional therapeutic oxygen and mechanical ventilation during the early months of life are at risk of developing early-onset, long-lasting respiratory disease that is related to an acquired BHR.

Ultrafast CT scoring system for assessing bronchopulmonary dysplasia: reproducibility and clinical correlation

PURPOSE

To evaluate the reproducibility of the Ultrafast CT (UFCT) scoring system and assess its usefulness in monitoring clinical severity in infants with bronchopulmonary dysplasia (BPD).

MATERIALS AND METHODS

UFCT scoring was done in 22 infants (15 boys and 7 girls aged 1 to 37 months) with BPD. A total of 258 lung fields were evaluated for the presence of hyperaeration, linear opacities, triangular subpleural opacities, and bronchovascular bundle distortion or thickening, and UFCT scores were given. Intraobserver and interobserver agreement and reproducibility of UFCT scores were statistically analyzed. In 12 patients, UFCT scores were linearly correlated with clinical severity scores based on respiratory dysfunction and complexity of care.

RESULTS

"Hyperaeration," which was the most frequent (18 of 22, 81.8%) finding, showed high concordance (kappa = 0.73, p < 0.001, kappa = 0.59, p < 0.001), and its UFCT scores significantly correlated with intraobserver and interobserver analyses (r = 0.94, p < 0.001, r = 0.82, p < 0.001, respectively). UFCT scores for hyperaeration significantly correlated with clinical scores (r = 0.75, p < 0.01), whereas those for the others did not.

CONCLUSION

UFCT is useful for assessing BPD. Hyperaeration was the most common and reproducible finding, and its extent significantly correlated with clinical severity.

Plasma thrombomodulin level in very low birthweight infants at birth

OBJECTIVE

Plasma soluble thrombomodulin level reflects endothelial damage. The plasma thrombomodulin level at birth is increased in asphyxiated full-term infants. There is no report of plasma thrombomodulin level in premature infants. To determine the thrombomodulin level in premature infants and whether it might reflect endothelial damage, we examined the plasma thrombomodulin level in very low birthweight (VLBW) infants at birth.

METHODS

Forty-five VLBW infants, of whom 14 had perinatal asphyxia complications, were recruited. As a control, 50 full-term infants without complications were also studied. Plasma thrombomodulin concentration, pH, base deficit, serum creatinine and D-dimer concentration, platelet count and fibrinogen concentration were measured within 1 hour after birth.

RESULTS

There were significant differences in plasma pH, creatinine concentration, platelet count, antithrombin III activity and D-dimer concentration between VLBW infants and full-term infants. Plasma thrombomodulin concentration (39.0 (16.6-93.7) vs 27.0 (16.6-39.1) microg/L, p < 0.0001) and plasma thrombomodulin-to-serum creatinine ratio (0.82 (0.19-2.65) vs 0.47 (0.24-0.70) microg/micromol, p < 0.0001) were significantly higher in VLBW infants than those in full-term infants. By univariate analyses for all neonates, there were significant relations between plasma thrombomodulin concentration and gestational age, birthweight, plasma pH, creatinine concentration, platelet count and antithrombin III activity. A stepwise multiple linear regression model using the above variables as dependent factors showed only birthweight contributed significantly to plasma thrombomodulin concentration (plasma thrombomodulin concentration (microg/l) = 45.677-0.006 (birthweight; g), r2 = 0.323, p < 0.0001, n = 94). Plasma thrombomodulin concentration and plasma thrombomodulin-to -serum creatinine ratio in VLBW infants with asphyxia were higher than in those without asphyxia, but not significantly different (43.2 +/- 17.7 vs 38.3 +/- 8.5 microg/l and 0.92 +/- 0.60 vs 0.83 +/- 0.37 microg/micromol).

CONCLUSION

Plasma thrombomodulin level in VLBW infants shows a high value at birth, and we consider the main factor responsible for this elevation may be endothelial damage or low clearance rate of thrombomodulin, which may be related to early gestational age.

Percutaneous central venous catheterization via the great saphenous vein in neonates

In 44 neonates (mean birthweight 1207 g and mean gestational age 30.0 weeks), very small central venous catheters were percutaneously inserted via the great saphenous vein on 46 occasions. Catheter-related complications such as catheter blockages in 17 (37%), edema in a unilateral leg in three (6%), and mechanical disruption in two (4%) were noted. Although two of the neonates were found to have bacteremia and five neonates died, none were catheter related. The optimal length of catheter insertion (Y) from the great saphenous vein at the level of the medial maleollus to the inferior vena cava at T9 and L3 was calculated by regression equations utilizing total body length (X). Radiographs taken with extended and flexed leg postures revealed that the catheter tips were retracted with extension of the lower extremities and the degree of displacement ranged from 1 to 4 (mean 2.7) vertebral levels. Because this movement might cause migration into veins that connect to the inferior vena cava, the catheter tip should be located between T9 and L3, except at the renal vein junction. Percutaneous central venous catheterization via the great saphenous vein is safe and useful. Regression equations provided for rapid estimation of the optimal length of insertion.

The effect of aerosolized furosemide in infants with chronic lung disease

To investigate whether aerosolized furosemide would improve pulmonary function in premature infants with chronic lung disease, we enrolled eight preterm ventilator-dependent infants in a cross-over, double-blind, placebo-controlled trial. Either aerosolized furosemide (2 mg/kg) or placebo (0.9% saline) was administered, and serial pulmonary function tests were performed before and at 1 and 2 h after each inhalation. After furosemide inhalation, static respiratory compliance increased significantly by 24.3% and 23.2% as percentage change from the baseline value at 1 and 2 h (p = 0.014 and 0.022, respectively). Also, tidal volume increased significantly by 33.8% and 28.7% at 1 and 2 h, respectively (p = 0.004 and 0.009). In contrast, no changes were observed in them after placebo inhalation. Total respiratory resistance was unchanged after both furosemide and placebo inhalation. There were no differences in urine volume in two groups. These data suggested that aerosolized furosemide improved pulmonary function in infants with chronic lung disease without excessive diuresis.

Two-dimensional electrophoresis of plant proteins and standardization of gel patterns

Proteins of two plants, Arabidopsis thaliana and rice (Oryza sativa) were subjected to two-dimensional electrophoresis analysis with two modifications: (i) comigration of external standard marker proteins with resultant horizontal and vertical stripes in the gel, and (ii) deblocking with a vapor of aqueous heptafluorobutyric acid for N-acetylserine. Approximately 5000 protein spots were separated from both the five tissues of Arabidopsis and the nine tissues of rice. Over one hundred spots were electroblotted for N-terminal sequencing. Among the newly sequenced proteins, 62 were from Arabidopsis and 51 from rice.

Inhibitory input to pause neurons from pontine burst neuron area in the cat

Extra- and intracellular recordings were made from pontine pause neurons (PNs) in the cat. Spontaneous spikes of PNs were suppressed after single shock stimulation of excitatory burst neuron (EBN) area immediately rostral to the abducens nucleus. The most effective stimulation site for the suppression was the region where long-lead burst neurons (LLBNs) were predominantly located. Intracellular recordings from PNs showed that stimulation of the LLBN area induced short-latency inhibitory postsynaptic potentials (IPSPs) in PNs and that steep hyperpolarization of PNs associated with quick phases of nystagmus occurred prior to an abrupt change in abducens nerve activity. Results suggest that a pause of PN spikes associated with quick phases is, at least in part, produced by inhibitory action mediated through LLBNs.

Convergence of skin reflex and corticospinal effects in segmental and propriospinal pathways to forelimb motoneurones in the cat

The organization of facilitatory convergence from cutaneous afferents (Skin) and the corticospinal tract (pyramidal tract, Pyr) in pathways to forelimb motoneurones of mainly distal muscles was studied in anaesthetized cats by analysing postsynaptic potentials (PSPs), which were spatially facilitated by combinations of stimuli to the two sources at different time intervals. Conditioning Pyr volleys facilitated Skin-evoked PSPs of fixed (1.2-3.6 ms) central latencies (Skin PSPs), suggesting that disynaptic and polysynaptic skin reflex pathways are facilitated from the pyramidal tract. The shortest latencies (1.2-1.7 ms) of pyramidal facilitation suggested direct connection of pyramidal fibres with last order neurones of skin reflex pathways. Conditioning Skin volleys facilitated Pyr-evoked PSPs of fixed, mostly disynaptic latencies (1.0-2.5 ms; Pyr PSPs), suggesting that pyramido-motoneuronal pathways are facilitated from Skin at a premotoneuronal level. The shortest pathway from skin afferents to the premotor neurones appeared to be monosynaptic. Although Pyr and Skin volleys were mutually facilitating, the facilitation curve of Pyr PSPs and that of Skin PSPs were discontinuous to each other, with the peak facilitation at different Skin-Pyr volley intervals. Transection of the dorsal column (DC) at the C5/C6 border had little effect on the latencies or amplitudes evoked by maximal stimulation and the pyramidal facilitation of Skin PSPs. In contrast, the facilitation of Pyr PSPs by Skin stimulation was greatly decreased after the DC transection, and the facilitation curve of Pyr PSPs was continuous to that of Skin PSPs, with no separate peak. Latencies of Pyr PSPs ranged similarly to those in DC intact preparations. More rostral DC transection (C4/C5 border) reduced Skin-facilitated Pyr excitatory PSPs (EPSPs) less than C5/C6 lesions, suggesting that the C5 segment also contains neurones mediating Skin-facilitated Pyr EPSPs. The results show that convergence from skin afferents and the corticospinal tract occurs at premotor pathways of different cervical segments. We suggest that corticospinal facilitation of skin reflex occurs mostly in the brachial segments and Skin facilitation of cortico-motoneuronal effects takes place largely in the rostral cervical segments and partly in the brachial segments.

Input-output organization in the hand area of the human motor cortex

The primate motor cortex consists of efferent zones which receive sensory information from a portion of limb in close anatomical relation to the muscle to which they project. To investigate a similar input-output relation in humans, we studied the effect of tactile stimuli on the size of motor evoked potentials (MEPs) elicited by transcranial magnetic and electrical stimulation. For tactile stimuli we applied air to the skin. The sizes of MEP of 3 finger muscles (flexor pollicis brevis, first dorsal interosseous, and abductor digiti minimi) with and without air stimuli were compared. Air stimuli applied to the tip of one finger facilitated mainly the magnetically evoked MEP of a muscle attached to that finger. A less obvious facilitatory effect was observed when giving stimuli on the dorsal aspect of the hand. Air stimuli had no facilitatory effect on electrically evoked MEPs. In one subject, there was no facilitatory effect even to magnetically evoked MEPs. In this subject, D-waves had the lowest threshold for magnetic and electrical stimulation. These results suggested that the effect was produced at the cortical level. This effect may correspond to the input-output relation found in the primate motor cortex.

Delayed gastric emptying in a neonate, associated with a partial defect in the gastric smooth muscle

A girl born after 36 weeks' gestation had emesis 15 hours after birth. She required total parenteral nutrition (TPN) because of persistent gastric retention. When milk was given, the volume of gastric aspirate 3 hours after feeding often was greater than the volume given. Domperidon and erythromycin were ineffective. Upper gastrointestinal series showed slow gastric emptying but no abnormalities in the stomach. No stenosis or obstruction below pylorus was found. Endoscopy showed normal gastric mucosa. Manometry showed normal antroduodenal motility patterns. Transpyloric feeding, which started at age 73 days, was successful and enabled cessation of the TPN. Laparotomy at 119 days of age showed partial absence of the muscle and serosal layer in the anterior wall of the gastric body (1 x 4 cm). The mucosal layer was intact and partly adhered to the peritoneum and the left lobe of the liver. The defect was surgically corrected by plicating the place. The postoperative course was excellent, and oral feeding was fully established within 2 weeks. Although the cause of the partial muscle defect in the case is unclear, this case suggests that this rare condition can cause severe chronic gastric retention.

Efficacy of long-term treatment with nipradilol, a nitroester-containing beta-blocker, in patients with mild-to-moderate essential hypertension

The effects of long-term treatment with nipradilol, a nitroester-containing beta-blocker, on casual and 24-hour blood pressures were studied in 70 patients with mild-to-moderate essential hypertension. Antihypertensive effects of nipradilol on casual blood pressure were observed in 68% of patients. Nipradilol reduced pulse rates, but no bradycardia was observed. The usefulness of nipradilol in the present study was 65%. The results of ambulatory blood pressure monitoring indicated that nipradilol reduced systolic blood pressure more than diastolic blood pressure, and reduced blood pressure during waking more than during sleep. These results suggest that nipradilol is a safe and useful long-term antihypertensive drug in both young and older patients with mild-to-moderate essential hypertension. When administered twice daily, nipradilol is effective throughout a 24-hour period.

Site of interaction between saccade signals and vestibular signals induced by head rotation in the alert cat: functional properties and afferent organization of burster-driving neurons

1. Extracellular spikes of burster-driving neurons (BDNs) were recorded within and immediately below the prepositus hypoglossi nucleus in the alert cat. BDNs were characterized by short-latency activation after stimulation of the contralateral vestibular nerve (latency: 1.4-2.7 ms) and the ipsilateral superior colliculus (latency: 1.7-3.5 ms). Convergence of vestibular and collicular inputs was found in all of 85 BDNs tested. Firing of BDNs increased during contralateral horizontal head rotation and decreased during ipsilateral rotation. A burst of spikes was induced in association with contralateral saccades and quick phases of nystagmus. 2. BDNs showed irregular tonic discharges during fixation. There was no significant correlation between the firing rate during fixation and horizontal or vertical eye position in most BDNs. During horizontal sinusoidal head rotation, the change in firing rate was approximately proportional to and in phase with contralateral head velocity. The phase lag of the response relative to head angular velocity was 13.8 +/- 20.1 degrees (mean +/- SD) at 0.5 Hz and 7.2 +/- 13.5 degrees at 0.2 Hz on the average. The gain was 0.88 +/- 0.25 (spikes/s)/(degrees/s) at 0.5 Hz and 1.19 +/- 0.49 (spikes/s)/(degrees/s) at 0.2 Hz. 3. Quantitative analysis of burst activity associated with saccades or quick phases indicated that the ON direction of BDNs was contralateral horizontal. The number of spikes in the burst was linearly related to the amplitude of the contralateral component of rapid eye movements. The slope of regression line was, on the average, 1.14 +/- 0.48 spikes/deg. There was no significant difference between the mean slopes for saccades and quick phases. The number of spikes depended on the difference between initial and final horizontal eye positions and not on the absolute eye position in the orbit. The mean burst firing rate was proportional to the mean velocity of the contralateral component of rapid eye movements. The slope of the regression line was 0.82 +/- 0.34 (spikes/s)/(degrees/s). Significant correlation was also found between intraburst instantaneous firing rate and instantaneous component eye velocity. 4. Objects presented in the contralateral visual field elicited a brief burst of spikes in BDNs independent of any eye movement. Contralateral saccades to the target were preceded by an early response to the visual stimulus and subsequent response associated with eye movement. 5. Excitation of BDNs produced by stimulation of the ipsilateral superior colliculus was facilitated by contralateral horizontal head rotation. Therefore saccadic signals from the superior colliculus to BDNs may be augmented by vestibular signals during head rotation.(ABSTRACT TRUNCATED AT 400 WORDS)

[Arrhythmias, autonomic function and spectral analysis of heart rate variation in patients with stable chronic pulmonary disease]

Autonomic function, the frequencies of arrhythmias, and outcome were studied in patients with stable chronic pulmonary disease (n = 67. Old tuberculosis, n = 35. Chronic pulmonary emphysema, n = 32) and in age-matched healthy elderly. The frequencies of arrhythmias were computed and spectral analysis was done with data obtained from 24-hour Holter ECG monitoring. The minimum heart rates of the patients were high. The minimum heart rate fell at night in the controls, but not in the patients. The patients had more PVCs than the controls, however sudden death due to arrhythmias did not occur. The LF/HF ratios obtained by spectral analysis of heart rate were lower in the patients than in the controls. There were no significant differences in age, respiratory rate, arterial blood gases, pulmonary-function tests, arrhythmias, or in the hourly distribution of the minimum heart rate between patients who died within 3 years and those who lived for more than 5 years. However, the LF/HF ratio in those who died was significantly lower than in the other groups. These results suggest that functional disturbance of the autonomic nervous system is related to outcome in patients with stable chronic pulmonary disease.

Excitation of the motor cortex associated with the E2 phase of cutaneous reflexes in man

We investigated excitability changes of the motor cortex associated with the E2 phase of cutaneous reflexes in the first dorsal interosseous muscle using transcranial electrical and magnetic stimulation of the motor cortex in humans. EMG responses to combined cutaneous and weak magnetic cortical stimulation, which were elicited during the E2 phase of cutaneous reflexes, were larger than those by the same magnetic cortical stimulation alone. This facilitatory effect was reduced or even inhibitory effect was seen when the intensity of cortical stimulation was increased. Responses to weak electrical cortical stimulation were less affected by the combined cutaneous stimulation. The same facilitatory effect on responses to weak magnetic cortical stimulation was also observed in single motor unit recordings, too. Dissociation between facilitatory effects on the responses evoked by weak magnetic and weak electrical cortical stimulations suggests that the motor cortical excitability is increased in association with the E2 phase. The present results are consistent with the hypothesis that the E2 phase is a kind of transcortical reflex.

Candidate premotor neurones of skin reflex pathways to T1 forelimb motoneurones of the cat

This study explored the locations and input-output properties of a large population of putative premotor neurones of skin reflex pathways in the cat. These neurones, interneurones excited by forelimb skin afferents and antidromically from the T1 motor nucleus (MN) and/or the lateral funiculus (LF, C8/T1 border), termed antidromic cells, were extracellularly recorded at C6-8. Selection of this site was based on data showing that cells retrogradely HRP labelled from the T1 MN were most numerous in C6-8 and the observation that transection of LF at the C8/T1 border abolished most skin-evoked postsynaptic potentials of T1 motoneurones. Antidromic cells were located in laminae IV-V, VI and VII. The latencies of antidromic excitation ranged from 0.4 to 1.8 ms, with a tendency for laminae IV-V cells to show longer latencies than laminae VI and VII cells. Latency of skin-evoked excitation ranged from 0.6 ms (IV-V cells), 0.8 ms (VI) and 1.4 ms (VII) to greater than 5 ms. The sum of the ortho- and antidromic latencies (estimated central latency) of individual cells explained the central latencies of skin-evoked postsynaptic potentials in T1 motoneurones. Skin-evoked firing responses (average of eight to ten cells) were earliest and largest in laminae IV-V antidromic cells, and latest and smallest in lamina VII cells. The antidromic cells who received inputs from muscle afferents and descending tracts. The following three results support the suggestion that the sampled antidromic cells are mostly premotor neurones. (1) Projection to the T1 MN via LF was verified in six laminae IV-VII antidromic cells, as tested with threshold mapping for antidromic excitation. (2) Three skin-excited axons of the middle LF projected to T1 MN, as revealed by intra-axonal staining (HRP). (3) PHA-L injection in laminae I-V of C8 anterogradely labelled terminals in lamina IX and LF axons at T1. It is suggested that last-order neurones of skin reflex pathways to T1 motoneurones are widely distributed in laminae IV-VII of C6-8 and consist of a variety of neurones with different locations and input patterns.

Structural analysis of non-volatile compounds by liquid chromatography/mass spectrometry and liquid chromatography/tandem mass spectrometry: thermal isomerization of benzylpenicillin in a Plasmaspray interface

Isomerization and degradation of benzylpenicillin ((2S,5R,6R)-3,3-dimethyl-7-oxo-6-(2-phenylacetamido)-4-thia-1- azabicyclo[3.2.0]heptane-2-carboxylic acid) were studied using a combination of Plasmaspray (PSP) liquid chromatography/tandem mass spectrometry (LC/MS/MS) and liquid secondary ion tandem mass spectrometry (LSI MS/MS). Benzylpenicillin was isomerized to benzylpenicillenic acid (3-mercapto-N-[[5-oxo-2-(phenylmethyl)-4(5H)- oxazolylidene]methyl]valine) in the PSP interface/ion source. The isomerization was inferred from the probe temperature dependence of PSP LC tandem mass spectra and discrepancies in the daughter ions between PSP LC and LSI tandem mass spectra. High temperature at the PSP interface was responsible for the isomerization, since the difference between PSP LC and LSI tandem mass spectra became smaller as the probe temperature was lowered. It was also found that benzylpenicillin was decomposed to benzylpenilloic acid (5,5-dimethyl-2-[(phenylacetamido)methyl]thiazolidine-4-carboxylic acid), N-(phenylacetyl)glycine, N-(phenylacetyl)glycinal and 3-mercaptovaline in the PSP interface/ion source. The degradation products formed in the interface/ion source were identical to those formed in acidic solution. The results show that degradation of penicillins can be investigated by PSP LC/MS and PSP LC/MS/MS.