Recent innovations in therapeutic endoscopy for pancreatobiliary diseases

The development of endoscopic treatment for pancreatobiliary diseases in recent years is remarkable. In addition to conventional transpapillary treatments under endoscopic retrograde cholangiopancreatography (ERCP), new endoscopic ultrasound-guided therapy is being developed and implemented. On the other hand, due to the development/improvement of various devices such as new metal stents, a new therapeutic strategy under ERCP is also advocated. The present review focuses on recent advances in the endoscopic treatment of pancreatic pseudocysts, walled-off necrosis, malignant biliary strictures, and benign biliary/pancreatic duct strictures.     

Potency of an inactivated influenza vaccine prepared from A/duck/Mongolia/119/2008 (H7N9) against the challenge with A/Anhui/1/2013 (H7N9)

H7N9 influenza virus infection in humans was reported in China on March 31, 2013. Humans are immunologically naïve to the H7N9 subtype, for which the seasonal influenza vaccine is not effective. Thus, the development of an H7N9 influenza virus vaccine is an urgent issue. To prepare for the emergence of an influenza pandemic, we have established a library comprising more than 1300 influenza virus strains with 144 different combinations of 16 HA and 9 NA subtypes. An H7N9 virus strain isolated from a 35-year-old woman, A/Anhui/1/2013 (H7N9), was found to be antigenically similar to H7N9 influenza viruses isolated from migratory ducks. In the present study, the potency of an inactivated whole virus particle vaccine prepared from an H7N9 low pathogenic avian influenza virus, A/duck/Mongolia/119/2008 (H7N9), selected from the library, was assessed by a challenge with A/Anhui/1/2013 (H7N9). The results indicate that the test vaccine was potent enough to induce sufficient immunity to reduce the impact of disease caused by the challenge with A/Anhui/1/2013 (H7N9) in mice. The present results indicate that an inactivated whole virus particle vaccine prepared from an influenza virus strain stored in the library could be useful as a vaccine strain in case of an influenza pandemic.     

Characteristics of the sequence effect in Parkinson's disease

The sequence effect (SE) in Parkinson's disease (PD) is progressive slowing of sequential movements. It is a feature of bradykinesia, but is separate from a general slowness without deterioration over time. It is commonly seen in PD, but its physiology is unclear. We measured general slowness and the SE separately with a computer‐based, modified Purdue pegboard in 11 patients with advanced PD. We conducted a placebo‐controlled, four‐way crossover study to learn whether levodopa and repetitive transcranial magnetic stimulation (rTMS) could improve general slowness or the SE. We also examined the correlation between the SE and clinical fatigue. Levodopa alone and rTMS alone improved general slowness, but rTMS showed no additive effect on levodopa. Levodopa alone, rTMS alone, and their combination did not alleviate the SE. There was no correlation between the SE and fatigue. This study suggests that dopaminergic dysfunction and abnormal motor cortex excitability are not the relevant mechanisms for the SE. Additionally, the SE is not a component of clinical fatigue. Further work is needed to establish the physiology and clinical relevance of the SE. © 2010 Movement Disorder Society.     

Plasma endothelin-1 levels depress optic nerve head circulation detected during the glucose tolerance test

Purpose To determine the relationship between the changes in optic nerve head (ONH) circulation and the level of plasma endothelin-1 (ET-1) during the glucose tolerance test (GTT). Methods Twenty-six healthy volunteers with normal GTT and 15 patients with mild hyperglycemia and abnormal GTT were studied. The ONH circulation [square blur rate (SBR) value], blood pressure, intraocular pressure (IOP), blood glucose, blood insulin and plasma ET-1 were determined before and every hour up to 3 h after an oral intake of 75 g of glucose. Results The SBR increased in the normal glucose tolerance group at all times during the GTT, but it decreased significantly in the abnormal glucose tolerance group (P < 0.05). Before the GTT, the plasma ET-1 level was not significantly different in the two groups; however, the level increased 1 h after the oral GTT in the abnormal glucose tolerance group (P < 0.05). No significant changes were observed in mean blood pressure or IOP. Conclusions ONH circulation increased after glucose intake in the normal glucose tolerance group and remained high even after the blood glucose level had returned to its baseline. The decrease in ONH circulation in the abnormal glucose tolerance group was attributed partly to the increased ET-1.     

Quantitative analysis of glia in the facial and vestibulocochlear nerves

Human normal vestibulocochlear and facial nerve trunks were cut off near the brain stem of the individuals who ages ranged from 24 to 93 years old. For this study, the discriminative staining method (Luxol fast blue--periodic acid-Shiff--hematoxylin triple stain) was adopted. It is admitted that the vestibulocochlear nerve medial to the internal auditory canal histologically resembles to the central nervous system in the rat. In order to confirm the fact in human, the intervening glial cells among nerve fibers were observed in the transverse section of vestibulocochlear and facial nerves. Schwann cells and microglia were observed among nerve fibers, but oligodendroglia. And the number of the glia was counted. The glial ratios related to the transverse nerve areas and the number of axons were calculated, and were examined in relation to aging. We found that there were more Schwann cells than microglia on both vestibulocochlear and facial nerves, facial nerve had more Schwann cells than vestibulocochlear nerve, and the number of Schwann cells per single myelinated fiber increased with age in the facial nerve. A quantitative study has not been included in the literature on the number of glia in the peripheral nervous system. Then, a quantitative study of human normal glial may be essential to elucidate pathogenesis regarding peripheral neuropathies, nerve injury or nerve sheath tumors as distinguished from the normal aging process.     

Maternal active and passive smoking and fetal growth: A prospective study in Nagoya, Japan

In order to examine the effect of maternal active and passive smoking on fetal growth, we carried out a population-based cohort study. A self-administered questionnaire was distributed to 15,207 women who notified their pregnancy from April, 1989 to March, 1991. A total of 7,411 mother-singleton infant pairs were analyzed in this study. Paternal smoking status and maternal hours exposed to environmental tobacco smoke (ETS) were used as indicators of passive smoking. Infants born to active smoking mothers were 96 g lighter, on an average, at birth than those born to non-smokers, and the relative risk for intrauterine growth retardation was 1.79 (95% confidence interval (CI) = 1.05-3.04) among active smoking mothers. Infants with smoking fathers weighted 11 g lighter, on an average, than those with non-smoking fathers, and mean birth weight of infants was reduced by 19 g among mothers exposed to ETS. The relative risk for intrauterine growth retardation in non-smoking pregnants with a smoking husband and those exposed to ETS was 0.95 (95% CI = 0.72-1.26) and 0.95 (95% CI = 0.71-1.26), respectively. Our findings indicated an adverse effect of maternal active smoking on fetal growth in Japanese pregnant population, but with small influence of maternal passive smoking.     

Screening of various plant extracts used in ayurvedic medicine for inhibitory effects on human immunodeficiency virus type 1 (HIV-1) protease

To identify substances with anti-human immunodeficiency virus (HIV) activity in traditional medicines, water and methanol extracts of crude drugs used in Indian traditional medicine (Ayurveda) were subjected to screening for their inhibitory effects on HIV type 1 protease (PR). The enzyme activity was determined by HPLC and of the 39 crude drugs tested, the extracts of the seeds of Areca catechu, the bark of Eugenia jambolana, the bark of Saraca indica and the stem bark of Terminalia arjuna inhibited the HIV-1 PR activity by more than 70% at a concentration of 0.2 mg/mL. The most potent inhibition was shown by the A. catechu extract, from which some procyanidins were isolated. One of them, arecatannin B1 showed significant HIV-1-PR inhibitory activity.     

Congenital neuropathy with the absence of large myelinated fibers

Twelve patients with hereditary motor and sensory neuropathy with the absence of large myelinated fibers have been reported. All of these patients had central nervous system involvement. In this report, we describe the first patient with pure motor and sensory neuropathy with the absence of large myelinated fibers without central nervous system involvement. Morphometric analysis of the biopsied sural nerve specimen revealed extremely small myelinated fibers compared with previously reported patients. It is supposed that the cause of this disease might be the abnormal development of axons of the peripheral nerves.     

Cerebellar granular layer degeneration in small cell lung cancer: paraneoplastic cerebellopathy or artifact?

The aim of our study was to ascertain whether granular cell degeneration represents uniquely an artifactual or a supravital event in patients with oat cell carcinoma. The material includes 52 cases of small cell lung cancer (SCLC). Formalin fixed and paraffin embedded representative cerebellar slides were stained routinely (HE, Klüver-Barrera), and some of them served as material for immunohistochemical study. The following antibodies were used: anti-ferritin, anti-GFAP, anti-IgG and anti-C3 complement fraction. Finally 5 cases out of our material could be diagnosed as paraneoplastic cerebellar degeneration (PCD), on the basis of lack of metastases within the CNS and concomitant intensive loss of Purkinje and granule cells. Clinically the cerebellar syndrome was disclosed in 3 cases. In the granular layer prevalence of microglial cell reaction was noted. GFAP-labeled astroglia were not demonstrated in the same intensity. Antisera to the C3 complement fraction showed moderate staining of Purkinje cell cytoplasm and in some cases also of granule cells. IgG immunostaining was disclosed in Purkinje cell cytoplasm and in 4 cases also in granule cell nuclei. The immunopathological changes presently observed and glial cell proliferation could be evidence for a nonartifactual origin of PCD.