Anosognosia in patients with Alzheimer's disease: current perspectives

Alzheimer?s disease (AD) is a neurodegenerative disease characterised by neurocognitive impairments, especially memory impairment, as core symptoms linked to reductions in activities of daily life. As marginal symptoms, neuropsychiatric symptoms (NPSs) appear during the progressive course of the disease. A lack of self‐awareness (anosognosia) of cognitive and functional impairments is often seen in patients with AD, and associations between anosognosia and other NPSs have been previously reported. To account for anosognosia pathogenesis neurocognitively, the cognitive awareness model (CAM) has been helpful for explaining the stream of events from sensory input to behavioural/affective and metacognitive outputs. According to CAM, there are three types of anosognosia: (i) primary anosognosia, (ii) executive anosognosia, and (iii) mnemonic anosognosia. These types of anosognosia are generated from different neurocognitive modulations leading to metacognitive outputs or behavioural/affective regulations. Primary anosognosia is considered to be caused by deficits in the metacognitive awareness system (MAS). While preserved MAS function is associated with milder depression and anxiety in AD, a severer depressive mood in patients with mild AD can inversely cause self‐underestimation. The modulation of executive anosognosia is thought to be associated with dangerous/disinhibition behaviours and apathy among NPS sub‐symptoms, via impairments of comparator mechanism (Cm) within the central executive system. Other neurobehavioral reactions linked to self‐awareness include ‘denying’ and ‘confabulation’, and each of these reactions is thought to be affected by the MAS and a Cm. Denial of one?s own memory impairments appears as a defensive reaction to protect against dysphoric feelings, and the confabulatory comment is instantly reaction constructed by fabrications according to misinterpretations of memory information about oneself. Similarly, the innovative development of a theoretical model (CAM) has contributed to explaining the mechanism of anosognosia and some neurobehavioral outputs from a neurocognitive perspective.     

Restless legs syndrome effectively treated with constant-pressure predilution online hemodiafiltration

Journal of Artificial Organs - We encountered a case of unstable predilution online HDF due to elevated transmembrane pressure (TMP) when performing constant-speed predilution online...     

High‐Performance Polybenzoxazine Derived from Polyfunctional Benzoxazine Composed of an Oligonuclear Phenolic Compound Having a 4,4′‐Dimethylenebiphenyl Linker

A novel polyfunctional benzoxazine monomer, OP‐a , is synthesized from aniline, formaldehyde, and an oligonuclear phenolic compound (OP) with a 4,4′‐dimethylenebiphenyl group as the phenol linker. After thermal curing of OP‐a up to 240 °C, a brown‐colored, transparent polybenzoxazine ( POP‐a ) film is obtained. The mechanical and thermal properties of the POP‐a film are investigated by tensile test, dynamic mechanical analysis (DMA), and thermogravimetric analysis (TGA). The POP‐a film is extremely tough compared with a typical polybenzoxazine ( PB‐a ) film. The elongation at break of the POP‐a film is 7.6%, which is surprisingly large for the highly cross‐linked thermoset. The high cross‐link density is suggested from the very high storage modulus (over 1 GPa) above the glass transition temperature (T _g) observed by DMA. The T _g of POP‐a is also improved significantly to T _g = 223 °C, which is approximately 50 °C higher than that of PB‐a . Moreover, TGA reveals that the thermal stability of POP‐a is also enhanced.     

Development of a compact and simple gas chromatography for oral malodor measurement

BACKGROUND: Volatile sulfur compounds (VSCs) in oral air are the only type of gases correlated with the strength of oral malodor. We developed a compact and simple gas chromatograph (GC) equipped with a newly invented indium oxide semiconductor gas sensor (SCS) for measuring the concentrations of VSCs in mouth air. We have assessed the correlation between measurements with a GC-SCS and those with a regular GC. METHODS: Oral air samples from randomly selected volunteers were analyzed with both a GC-SCS and a GC with a flame photometric detector (FPD), which is specific to VSCs, and GC-SCS measurements were compared to those obtained by GC-FPD. Subsequently, oral air samples before and after mouthrinsing with 5% ethanol mouthwash were analyzed to determine the effect of ethanol on VSC measurements by GC-SCS. RESULTS: There were strong correlations between VSC concentrations determined using these two gas chromatography methods (hydrogen sulfide, R=0.821, P<0.0001; methyl mercaptan, R=0.870, P<0.0001; and dimethyl sulfide, R=0.770, P<0.0001). Although GC-SCS can differentiate ethanol and VSCs in oral air samples after mouthrinsing, GC-SCS measurements demonstrated higher values than those obtained by GC-FPD; however, this discrepancy improved over time due to the reduced effect of ethanol. CONCLUSION: The results suggest that GC-SCS may be useful for the diagnosis of halitosis.     

Etidronate inhibits human osteoblast apoptosis by inhibition of pro-apoptotic factor(s) produced by activated T cells

Humoral factors produced by activated T cells are thought to be important in the development of bone loss in patients with rheumatoid arthritis (RA). We investigated the inhibitory effect of etidronate disodium (EHDP) on apoptosis of human osteoblasts induced by supernatants from in vitro activated T cell cultures. Human osteoblastic cell line MG63 cells and human primary osteoblast-like cells were used in the present study as human osteoblasts. T cells were incubated with interleukin-2 and further activated with 1 2-o-tetradecanoyl-phorbol 13-acetate and ionomycin, either in the presence or absence of EHDP. After we carried out the cultivation, we examined the cytotoxicity of cultured T cell supernatants toward MG63 cells and human primary osteoblast-like cells. Supernatants from activated but not resting T cell cultures efficiently induced apoptosis of MG63 cells and primary osteoblast-like cells. Supernatants from activated T cell cultures, incubated with EHDP, exhibited significantly less cytotoxicity than did supernatants incubated in the absence of EHDP. In contrast, the cytotoxicity of activated T cell culture supernatants was not affected by direct treatment of human osteoblasts with EHDP. The concentration of soluble Fas ligand in activated T cell culture supernatants was actually increased by EHDP. However, EHDP did not influence soluble Fas and tumor necrosis factor-alpha concentrations in the supernatant. Furthermore, treatment of human osteoblasts with EHDP did not alter their expression of Bcl-2/Bcl-xL or their sensitivity to anti-Fas immunoglobulin M-induced apoptosis. Our results suggest that EHDP inhibits the production of soluble factor that induces apoptosis of human osteoblasts and thus exhibits a protective action toward human osteoblast apoptosis induced by activated T cell culture supernatants. Although the exact EHDP-regulated molecule that induces apoptosis of human osteoblasts is unknown at present, our study may explain part of the therapeutic action of bisphosphonates in RA complicated by bone loss.     

Upregulation of CD80 on glomerular podocytes plays an important role in development of proteinuria following pig‐to‐baboon xeno‐renal transplantation – an experimental study

We have previously reported that co‐transplantation of the kidney with vascularized donor thymus from α‐1,3‐galactosyltransferase gene knockout pigs with an anti‐CD154 with rituximab‐based regimen led to improved xenograft survival in baboons with donor‐specific unresponsiveness. However, nephrotic syndrome emerged as a complication in which the glomeruli showed mild mesangial expansion with similarities to minimal change disease (MCD) in humans. Since MCD is associated with CD80 expression in glomeruli and elevated urinary excretion, we evaluated a potential role for CD80 in xenograft nephropathy. Study 1 confirmed high urinary CD80 excretion in nephrotic animals with renal xenografts showing CD80 expression in glomeruli. In Study 2, baboons receiving xenografts received CTLA4‐Ig once a week from the second postoperative week or no CTLA4‐Ig. The non‐CTLA4‐Ig group developed severe proteinuria with modest mesangial expansion with high urinary excretion of CD80 and documented CD80 expression in glomerular podocytes. All of the recipients in non‐CTLA4‐Ig groups had to be euthanized before POD 60. In contrast, CTLA4‐Ig group showed a marked reduction in proteinuria and survived significantly longer, up to 193 days. These results demonstrate that anti‐CD80 targeted therapy represents a promising strategy for reduction of proteinuria following renal xeno‐transplantation with improved survival.