Periodic limb movements and sleep-wake disorder

Abstract The relationship of periodic limb movements (PLM) and Sleep-wake disorders in 11 patients was investigated. Two patients complained of insomnia. A patient with cervical spinal canal stenosis had a complaint of difficulty in initiating sleep. Movement index (MI) was 51 and PLM arousal index was 8. A patient with chronic hemodialysis had a complaint of difficulty in initiating and maintaining sleep. MI was 79 and PLM arousal index was 51. One patient with myotonic dystrophy showed 79 in MI and 3 in PLM arousal index. It is suspected that myotonic dystrophy is less sensitive to stimuli during sleep (i.e. PLM). These results suggest that the sleep-wake disorders associated with PLM relate to the threshold of awakening.     

Impact of Intraoperative 3-Tesla MRI on Endonasal Endoscopic Pituitary Adenoma Resection and a Proposed New Scoring System for Predicting the Utility of Intraoperative MRI

The aim of this study was to evaluate the impact of 3-Tesla intraoperative high-field magnetic resonance imaging (3T-iMRI) for pituitary adenoma resection, and to propose a new scoring system for predicting the utility of 3T-iMRI. This retrospective study evaluated 82 patients with pituitary adenoma who underwent purely endoscopic endonasal resection with 3T-iMRI between 2015 and 2019. 3T-iMRI revealed unexpected residual tumor in 39 cases (47.6%), which led to further resection and contributed to upgrading of the resection level in 28 cases (34.1%), which led to gross total resection rates (GTRs) of 67.1% and near total resection of 15.9%. To construct a new scoring system, patients were divided into a discovery cohort (56 patients) and a validation cohort (26 patients). Three variables for the scoring system were selected according to a univariate analysis of the discovery cohort: the size of the tumor (>20 mm: 1 point), the presence of suprasellar tumor lobulation (1 point) and the history of previous operations (1 point). The risk of additional resection after iMRI was well stratified by this scoring system (range 0–3; p = 0.0037 for trend). Robustness of the system was confirmed in the validation cohort (0 points, 0%; 1 point, 30.8%; 2 points, 70.0%; 3 points, 100%; p = 0.0116 for trend). These results indicate that 3T-iMRI optimized the extent of resection, even with the use of an endoscope, and that the proposed scoring system is useful for predicting whether 3T-iMRI is likely to be of value for a particular patient.     

Twenty-Seven-Year Follow-up of Arrhythmogenic Right Ventricular Dysplasia

OBATA, H., et al. : Twenty-Seven-Year Follow-up of Arrhythmogenic Right Ventricular Dysplasia. This case report describes clinical features, especially of surface ECG changes, observed for 27 years in a patient with arrhythmogenic right ventricular dysplasia (ARVD). The course of this patient was characterized by progressive deterioration of right ventricular function and progression of delayed potentials (so-called epsilon waves) following QRS complexes. However, the relation between ventricular arrhythmias and ECG changes or the degree of right ventricular abnormality was difficult to discern.     

Role of Na+-H+ Exchange on Reperfusion Related Myocardial Injury and Arrhythmias in an Open-Chest Swine Model

The inhibition of Na⁺-H⁺ exchange (NHE) with amiloride analogues in vitro has been shown to prevent reperfusion arrhythmias and additional cell necrosis. Inhibition of intracellular Ca²⁺ overload via NHE inhibition has been suggested as a mechanism of these protective effects. The aim of this study was to examine whether treatment with amiloride analogues reduces the incidence of reperfusion arrhythmias and limits infarct size in vivo. Open-chest swine were exposed to a 30-minute left anterior descending artery (LAD) occlusion and 180 minutes of reperfusion during atrial pacing at 150 ppm. Intravenous 5-(N,N-dimethyI)-amiloride (AML, 5 μg/kg per min) was administered in the treatment group (n = 7) and intravenous saline in the control group (n = 7), starting 10 minutes before coronary occlusion. The infusion was continued during ischemia and reperfusion. The area at risk was defined by monastral blue dye and infarct size by triphenyltetrazolium chloride staining. Limb leads ECG and monophasic action potentials (MAPs) from the epicardium in the ischemic area were recorded. There was no significant difference in the size of the area at risk and hemodynamic parameters between the groups. However, the infarcted area was 0.4%± 1.0% of the area at risk in the treatment group, whereas it was 62%± 29% in the control group (P < 0.05). Pathological examination (Hematoxylin-eosin and mallory s phosphotungstic acid-hematoxylin staining) revealed that all of the infarcted area consisted of contraction band necrosis. MAP duration in both groups was significantly shortened during ischemia. After reperfusion, MAP duration in the treatment group recovered earlier than that of control group. However, there was no significant difference in the incidence of ventricular tachyarrhythmia between the groups. Inhibition of NHE with AML prevented reperfusion related cell necrosis in the in vivo swine model, but did not reduce the incidence of ventricular tachyarrhythmia.     

Primary cutaneous T-cell lymphoma with an angiocentric growth pattern: association with Epstein-Barr virus

Summary We report a case of primary cutaneous T-cell lymphoma with an angiocentric growth pattern. The lesions had been confined for about 2.5 years to the skin, but there had been a gradual progression of the disease both clinically and histologically. We assessed the neoplastic clonality and the presence of Epstein-Barr (EB) virus genome in this case using immunohistochemistry. Southern blot analysis and RNA in situ hybridization. Clonal proliferation of a CD4⁺αβT-cell phenotype was demonstrated. In addition, the clonal population harboured the EB virus genome, which suggested that the virus was involved in the pathogenesis of the disease. The patient has remained in remission for 10 months, and has received treatment with cyclophosphamide and prednisone.     

Test—retest reliability of the Personality Diagnostic Questionnaire: Revised

Abstract  We describe the test-retest reliability of the Personality Diagnostic Questionnaire: Revised (PDQ-R), which was developed to assess DSM-III-R personality disorders (PD). Thirty patients, diagnosed clinically with PD, filled out the PDQ-R twice at 1 month intervals after having undergone 8 weeks of treatment leading to moderate resolution of their acute axis-I symptomatology. The chance-corrected agreement was almost perfect for all DSM-III-R PD (K coefficients: 0.76–1.00). Dimensional scores for individual PD and the total PDQ-Q score were highly correlated (Pearson's correlation coefficients: 0.62–0.99) and the mean of scores did not significantly differ between test and retest. Based on these results, we propose that highly reliable PD diagnoses are possible, even using a self-report questionnaire, if the axis-I symptoniatology of depression and anxiety have moderately subsided. These results clarify controversy over how and when reliable PD diagnoses may be obtained via a self-report questionnaire in a clinical sample.     

Smoking behaviour and personality: a population-based study in Japan

Abstract Aims . The aim of our study was to determine whether the previously reported findings also apply to a general population in Japan and whether, among current smokers, such personality characteristics can be correlated with the age they started to smoke and their present daily consumption of cigarettes . Design . Cross-sectional survey . Setting . Miyagi prefecture, in northern Japan . Participants . 20 538 residents in Miyagi, aged 40-64 years . Measurement . A self-administered questionnaire involving smoking status (current, ex- and non-smokers) and patterns and the Japanese version of the short-form Eysenck Personality QuestionnaireRevised (EPQ-R) . Findings . (1) Current and ex-smokers were higher on Extraversion and Psychoticism than non-smokers for both genders. (2) Heavy smokers were higher on Psychoticism than light smokers and those who started to smoke prior to the legally permitted age were higher on Psychoticism than those who did not . Conclusions . (1) Our study confirmed that the findings which had been previously reported in selected samples in western countries also apply to a general population in Japan; (2) current smokers were found to be heterogeneous in terms of Psychoticism when the age they started to smoke and their present daily consumption of cigarettes were taken into account.     

CASE REPORT: Fibrosing cholestatic hepatitis after living related-donor renal transplantation

A 43-year-old man underwent living related-donor renal transplantation because of chronic renal failure in 1991. During the transplant period, both donor and recipient were seronegative for hepatitis B surface antigen (HBsAg). The donor was seropositive for antibody to hepatitis B surface antigen (anti-HBs) due to hepatitis B virus (HBV) vaccination. After transplantation, FK506 and methylprednisolone had been administered to the patient as immunosuppressants. In 1993, HBsAg appeared in his serum. His alanine aminotransferase level elevated gradually during 1995 and then in 1996, general fatigue, ascites and jaundice developed. At this time his serum was positive for hepatitis B e antibody, contained more than 100000 Meq/mL HBV-DNA and 100% precore mutant. Despite subsequent intensive therapy, liver dysfunction progressed and this patient died of hepatic failure 2 months following admission. At autopsy, the liver exhibited cholestasis, fibrosis extending from the portal tracts, mild inflammation and hepatocytes with a ground-glass appearance. In addition, HBsAg and hepatitis B core antigens had accumulated in the hepatocytes. Consequently, the final diagnosis was fibrosing cholestatic hepatitis (FCH) due to precore mutant HBV infection contracted after renal transplantation. It is unclear when and where the recipient liver became HBV infected. Nevertheless, after renal transplantation, while receiving immunosuppressive drugs, HBV appeared to have the potential to cause hepatic failure and FCH may have been a fatal complication for the recipient.     

α-Helix structure of parathyroid hormone fragment (1–34) predicted by Monte Carlo simulated annealing

Tertiary structure of parathyroid hormone fragment (1–34) is predicted by the Monto Carlo simulated annealing method. Among the 20 structures obtained after completely unbiased calculations, the lowest-energy conformation exhibits two α-helices around residues 2–10 and 18–22. This structure agrees with the models, especially with the location of helices, deduced from experiments. In addition, the simulation supports empirical implications in the following two points. (1) The helix near the N-terminus is more stable than the C-terminal one. (2) The rest of the peptide segments are flexible and do not tend to have any definite structure. Our calculation correctly predicts only an α-helix, whereas previous analyses by the Chou–Fasman method leave an ambiguity between an α-helix and a β-strand.