The behaviour of red cells in narrow tubes in vitro as a model of the microcirculation

To investigate the behaviour of red cells in the microcirculation, we established a new capillary method using narrow fluorinated ethylenepropylene copolymer tubes with internal diameters of 12.5 and 25.0 μm. Red cell flow in the tubes under a given range of pressure was analysed through a video system connected to a microscope. The experimental condition was adjusted so that the velocity of the control normocytes would be compatible with that in corresponding vessels in vivo , 0.5–1.5 mm/s. In the 12.5 μm tube, normocytes obtained from 12 young normal volunteers ran in an axisymmetric edge-on orientation with a folded shape at higher pressures, but rolled along freely without deformation at lower pressures. Deformation during the passage of the microcytes obtained from four patients with polycythaemia vera complicated with iron-deficient microcytosis and 10 patients with iron deficiency anaemia was relatively mild, whereas that of the macrocytes obtained from eight patients with refractory anaemia was marked. Even after the screening effect at the tube entrance was taken into consideration, the velocities of both microcytes and macrocytes were found to be significantly lower than the control normocytes. Therefore this method may be a new way to investigate the flow properties of red cells in the microcirculation.     

M-Dot-ELISA检测麻风家内接触者血清中麻风杆菌特异性抗原

用改良酶联免疫斑点１５试验（简称 Ｍ－Ｄｏｔ－ＥＬＩＳＡ）对麻风家内接触者（ＨＣ）血清进行了麻风杆菌特异性酚酚糖脂Ｉ（ＰＧＬ－Ｉ）抗原检测。７５例ＨＣ均经麻风杆菌明胶微粒凝集试验（ＭＬＰＡ）和酶联免疫吸附试验（ＥＬＩＳＡ）证实为麻风杆菌特异性抗体阳性者。结果表明：①７５例ＨＣ中抗原阳性者１６例，阳性率为２１％。接触多菌型麻风（ＭＢ）者的抗原阳性率（２８％）明显高于接触少菌型麻风（ＰＢ）者（０％），两者之间有极显著性差异（ Ｐ ＜０．０１ ）。②抗体弱、强阳性组的抗原阳性率和抗原量之间亦有极显著差异（Ｐ＜０．０１）。③４０例正常人及１０例经ＭＬＰＡ和ＥＬＩＳＡ检测证实特异性抗体阳性的非麻风患者血清标本，抗原检测均阴性。     

A vesicular variant of bullous pemphigoid with autoantibodies against unidentified 205- and 150-kDa proteins at the basement membrane zone

Summary We describe a 75-year-old man who developed a vesicular variant of bullous pemphigoid with a distinctive result of immunoblot analysis. Characteristic symptoms consisted of vesiculopapular eruptions with erythematous patches on the arms and legs, many of which fused to form irregularly outlined areas of erythema varying in size. Direct immunofluorescence revealed a linear deposition of IgG at the basement membrane zone of the skin, and indirect immunofluorescence detected circulating IgG autoantibodies at a titre of 1: 160. which reacted with the antigens located on the epidermal side of skin split with 1 mol/L, NaCI. Immunoblot analysis using epidermal extracts demonstrated the presence of IgG antibodies directed to 150, 205, 240 and 280 kDa proteins as well as to the 180kDa bullous pemphigoid antigen (BPAG2). All antibodies eluted from nitrocellulose membrane imprints of individual bands with molecular weights of 150, 180 and 205 kDa were found by indirect immunofluorescence to react with the basement membrane zone, whereas those elutcd from the bands with molecular weights of 240 and 280 kDa did not. These findings suggest that antibodies directed not only to the 180kDa BPAG2, but also to 150 and 205 kDa proteins, are involved in the pathogenesis of bulla formation in this patient.     

Catheter Ablation of Ventricular Tachycardias Due to Forward and Reverse Propagation Across a Reentrant Circuit Inside a Nonischemic Biventricular Aneurysm

Ablation of Bidirectional VT. A 64‐year‐old recipient of implantable cardioverter defibrillator presenting with a 4.7 × 3.3 cm nonischemic, biventricular aneurysm developed multiple electrical storms due to ventricular tachycardia (VT) with 2 distinct QRS morphologies. Endocardial electroanatomical mapping revealed the presence of a low‐voltage area corresponding to the aneurysm, where multiple delayed potentials were recorded. Activation mapping and entrainment pacing of both VT revealed the, respectively, forward and reverse propagation of the wavefront across a single reentrant circuit inside the ventricular aneurysm. Delivery of 3 applications of radiofrequency energy to a critical segment of the reentrant pathway eliminated both VT and the electrical storms. (J Cardiovasc Electrophysiol, Vol. 22, pp. 467‐467)     

Different Antiphospholipid Antibody Specificities are Found in Association with Early Repeated Pregnancy Loss Versus Recurrent IVF-Failure Patients

PROBLEM: Patients having in vitro fertilization and embryo transfer (IVF-ET) failures show an increased incidence of antiphospholipid (aPL) antibodies; but controversy exists whether aPL can induce IVF-failure. This study was designed to compare aPL specificities between recurrent IVF-failure patients versus repeated early pregnancy loss (RPL) patients. METHOD OF STUDY: Anticardiolipin (aCL), lupus anticoagulant (LA), antiphosphatidylserine (aPS), antiphosphatidylethanolamine (aPE), and antinuclear antibodies (ANA) were measured in 74 recurrent IVF-ET failure patients and compared with 273 early RPL patients ( < 10 weeks). RESULTS: An increased incidence of IgG-aPE and ANA was observed for both groups in comparison with controls. Patients with recurrent IVF-ET failure showed a significantly higher prevalence of IgG-aPS (P = 0.02) and IgG-aCL (P = 0.02) when compared with early RPL patients or controls. CONCLUSIONS: IgG-aPS and IgG-aCL may be responsible for some IVF-failures. Additional studies are needed to clarify the pathogenic role of IgG-aPS and IgG-aCL on IVF-ET failure.     

The prevalence and pattern of insomnia in Japanese industrial workers: Relationship between psychosocial stress and type of insomnia

We examined the prevalence of insomnia among Japanese male industrial workers and analyzed the effect of psychosocial stress on the prevalence of three types of insomnia: `difficulty in falling asleep', `frequent sleep interruption' and `early morning arousal'. The study population consisted of male day workers (n = 319) in a manufacturing heavy industry company located in Nagasaki City, Japan. The subjects answered a questionnaire consisting of six sleep-related items and 24 questions related to occupational and private life conditions. A total of 271 men (average age 40.9 years) completed the questionnaire; a response rate of 85%. Insomnia within the month preceding the survey was present in 27.7% of the workers (75/271). Multiple logistic regression analysis demonstrated that different psychosocial stressors were associated with different types of insomnia. Visual display terminal (VDT) work overload was significantly associated with all types of insomnia, while `over-involvement in the job' was associated with difficulty in falling asleep and early morning arousal. Our results demonstrated that the prevalence of insomnia in Japanese workers is similar to that reported among European and American general adult population. Our results also indicate that the use of VDT in the workfield is associated with insomnia.     

Preliminary early intervention study using Nursing Child Assessment Teaching Scale in Japan

Background: Mother–infant interactions have been acknowledged as one of the most important elements in measuring outcomes of parent support and infant mental health interventions. The present study was conducted to measure early intervention outcomes using the Nursing Child Assessment Teaching Scale (NCATS), and to identify factors that affected Japanese mother–infant interactions. Methods: Healthy Japanese mother–infant dyads who had lower scores on the NCATS, indicating potential problems, were assigned to an intervention group, and compared with a control group who had higher scores on NCATS. Health‐care professionals visited the intervention group dyads in their homes, and gave them positive feedback on their interactions, consultations on parenting, and health advice. The control group dyads had home visitation once every 6 months for assessment only. Results: The home visitations started at 3 months of age and continued until 18 months. NCATS scores in both groups were significantly different at baseline but differences faded by the end, which suggests that the intervention promoted improved interactions in the intervention group. Two of five factors were identified as influencing mother–infant interactions: maternal age; and personal networks, and together they significantly explained 27–30% of NCATS variance. Conclusion: The results appear to support the validity of measuring Japanese mother–infant interactions with NCATS. This study is the first to measure the outcomes of early intervention on Japanese dyads’ interactions using NCATS. Additional replication studies should be conducted elsewhere in Japan, and clinical practices for promoting mother–infant interactions should begin to assess their effectiveness with NCATS as an outcome measure.     

Ten cases of sebaceous carcinoma arising in nevus sebaceus

Although nevus sebaceus is known to develop various types of secondary neoplasms, it rarely causes carcinoma and only 14 cases of secondary sebaceous carcinoma have been reported. In this study, 10 cases of sebaceous carcinoma arising in nevus sebaceus were collected. The clinicopathological features and results of immunohistochemical examinations with adipophilin, perilipin and p53 were summarized. Sebaceous carcinoma arising in nevus sebaceous predominantly occurred on the scalp (8/10) of elderly women (mean age, 67.7 years). No case was associated with Muir–Torre syndrome. We found several pathological features of sebaceous carcinoma; that is, made up mainly of germinative cells, moderate nuclear atypia without pleomorphism and many mitoses (4–28/10 high‐power field). Adipophilin and perilipin antibodies highlighted lipid drops in the cytoplasm of the malignant cells in all cases. Overexpression of p53 was seen in all cases. In two cases there were coexisting benign‐looking sebaceous lesions at the periphery of the main cancer nodule, and in these lesions p53 showed low positivity compared with the clearly malignant area. There was co‐occurrence of another neoplasm in three cases with trichoblastoma, sebaceoma and syringocystadenoma papilliferum, respectively. All cases were treated by excision of the malignant lesion, with or without inclusion of the nevus sebaceus. In a follow‐up period of 1–7 years, there was no case of recurrence, lymph node metastases or distant metastases. With these specific pathological and immunohistochemical findings using adipophilin, perilipin and p53, we have to consider the possibility that there is a tendency to underdiagnose secondary sebaceous carcinomas in nevus sebaceus. These clinicopathological features of sebaceous carcinomas developing in the nevus sebaceus seem to indicate different biological entities from de novo sebaceous carcinoma.