Peroxiredoxins are involved in the pathogenesis of multiple sclerosis and neuromyelitis optica spectrum disorder

Peroxiredoxins (PRXs) are intracellular anti-oxidative enzymes but work as inflammatory amplifiers under the extracellular condition. To date, the function of PRXs in the pathogenesis of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) is not fully understood. The aim of this study was to investigate whether PRXs play a role in the pathogenesis of MS and NMOSD. We analyzed levels of PRXs (PRX1, PRX5 and PRX6) in the cerebrospinal fluid (CSF) and serum of 16 patients with MS, 16 patients with NMOSD and 15 patients with other neurological disorders (ONDs). We identified potential correlations between significantly elevated PRXs levels and the clinical variables in patients with MS and NMOSD. Additionally, pathological analyses of PRXs (PRX1-6) in the central nervous system (CNS) were performed using the experimental autoimmune encephalomyelitis (EAE), animal model of MS. We found that serum levels of PRX5 and PRX6 in patients with MS and NMOSD were higher compared with those in patients with ONDs (P < 0·05). Furthermore, high levels of PRX5 and PRX6 were partly associated with blood–brain barrier dysfunction and disease duration in NMOSD patients. No significant elevation was found in CSF PRXs levels of MS and NMOSD. Spinal cords from EAE mice showed remarkable PRX5 staining, especially in CD45⁺ infiltrating cells. In conclusion, PRX5 and PRX6 may play a role in the pathogeneses of MS and NMOSD.     

Viable myocardium identified by reinjection thallium-201 imaging: comparison with regional wall motion and metabolic activity on FDG-PET.

Reinjection thallium-201 scans were performed in 68 patients with coronary artery disease after the routine stress-delayed scans for more accurate identification of new fill-in. Following the stress and 3 hour delayed thallium-201 SPECT scans, 40 MBq (1.1 mCi) was injected at rest, and 10 min later, the reinjection SPECT scan was obtained. To determine whether the reinjection method can aid in identifying ischemic but viable myocardium, the thallium-201 findings were compared with regional wall motion on radionuclide ventriculography in 61 patients and with metabolic activity on positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) in 18 patients. The reinjection scan identified new fill-in which had not been shown on the stress-delayed scans in 6 of the 22 patients (27%) or in 29 of the 105 segments (28%). Regional wall motion was preserved more in the segments that exhibited new fill-in after reinjection (wall motion score = 1.64 +/- 1.29) than in those without new fill-in (score = 2.72 +/- 1.04) (p < 0.01). In the comparative study with FDG-PET, persistent FDG uptake was observed in all segments with new fill-in (20/20 segments: 100%); whereas, it was seen in only 7 of the 28 segments (25%) without new fill-in after reinjection (p < 0.05). We concluded that the segments having new fill-in after reinjection may represent ischemic but viable myocardium. Thus, the reinjection thallium-201 scan should be performed to identify ischemic myocardium which occasionally cannot be detected by the routine stress-delayed thallium-201 scans.     

Fourier analysis of binocular VEP with stimulation of fusional areas

Dioptic stimulation, by which each eye was stimulated by the same checkerboard pattern but at different pattern reversal rates, was performed and the visually evoked potentials (VEP) were analyzed with a Fourier processor. When both images from each eye were superimposed using fusional targets and prisms, the intermediate frequency component (IFC) was recognized besides two components corresponding to each stimulating frequency reversal rate. The relationship between IFC and the superimposed area (SA) was studied. IFC appeared clearly when the visual angle of SA was above 60 min. (18% of SA). The amplitude of IFC was saturated at a visual angle of 140 min. (53% of SA). Furthermore, when the SA was 200 min. of the visual angle (100% of SA), the IFC showed 0.6 times the activity of the monocular component. When dioptic stimulation was used, only one component corresponding to the stimulating pattern rates was observed and the amplitude became higher with increase of SA. The amplitude of the SA (areas of each eye were fully superimposed) was 1.4 times greater than that of 0% SA.     

Cerebral Infarction due to Disseminated Intravascular Coagulation with Thromboexclusion for Dissecting Aortic Aneurysma

Abstract: Cserebral infarction due to chronic disseminated intravascular coagulation (DIC) after thromboexclusion for thoracic dissecting aortic aneurysma is described.
Chronic DIC may be caused by the delay of thrombus formation at the site of thromboexclusion, and local DIC occurred at that site. It is difficult to find chronic DIC. This case shows that DIC after thromboexclusion for dissecting aortic aneurysma may be one of the causes of recurrent cerebral infarction.     

Study for tumor-initiating effect of acetaminophen in two-stage liver carcinogenesis of male F344 rats

The potential liver-tumor-initiating activity of acetaminophen(paracetamol, APAP) was investigated in male F344 rats. APAPwas administered by intragastric intubation either as 10 dosesof 1 g/kg body weight over 5 weeks or as a single dose of 0.5g/kg body weight 24 h after two-thirds partial hepatectomy.These initiating treatments were followed by administrationof 0.1% phenobarbital in the drinking water for 12 weeks asthe promoting regimen. Quantitative examination of placentalglutathione S-transferase-positive foci revealed no enhancingeffect of APAP on the induction of the foci consisting of morethan two positive cells with either initiating treatment. Ifsolitary positive hepatocytes were included in the effectivenumber of foci, 10 repeated doses of 1 g/kg APAP increased thenumber of foci while the validity of the single positive cellsis uncertain. This dose of APAP caused centrilobular necrosis.By ³²P-postlabeling, although the active metabolite of APAPformed DNA adducts when incubated with isolated DNA, no DNAadduct formation was detected in the liver of rats either fed0.1–1.5% APAP for 1 week or given 1 g/kg by gastric intubation.These results indicate that APAP possesses no tumor-initiatingactivity in the rat liver.     

Interstitial deletion of the long arm of chromosome 6 associated with absent pulmonary valve

We report on a newborn infant with a deletion of 6q and absent pulmonary valve. His chromosome constitution was 46,XY,del (6) (q15q21). To our knowledge this is the first case with such combination. Some of his clinical features were found in common in 2 previous 6q- cases with the same breakpoints.     

Carcinoma of the ampulla of vater: Histopathologic analysis of tumor spread in Whipple pancreatoduodenectomy specimens

Controversies exist regarding the application of the pylorus-preserving pancreatoduodenectomy (PPPD) to malignancies. This study was intended to disclose the pattern of spread of ampullary cancer and to substantiate that tumor spread at resectable stages does not involve the tissues preserved by PPPD. We examined 40 consecutive Whipple pancreatoduodenectomy specimens: mucosal cancer, 4 cases; cancer invading (but not penetrating) the sphincter of Oddi, 1; cancer invading the submucosa of the duodenum, 12; cancer invading the proper muscle of the duodenum, 5; cancer invading the subserosal layer of the duodenum, 7; and cancer invading pancreatic parenchyma, 11. Five cases of mucosal cancer or cancer invading (but not penetrating) the sphincter spread locally without nodal involvement and showed a 5-year survival of 80% without recurrence, being better (p<0.05) than the 40% survival for patients with more advanced cancers. Sixty-three percent of the remaining 35 cases had metastasis to regional lymph nodes. The 5-year survival of 28% among those with cancer penetrating the proper muscle was worse (p<0.05) than the 59% survival for those with less advanced cancers. No cases had involved the anatomic structures that would have been preserved by a PPPD. In three cases (7.5%), gastric cancer coexisted. In conclusion, ampullary cancer not penetrating the sphincter spreads locally. Once penetrating the sphincter, it often spreads regionally and causes recurrence. Cancer penetrating the proper muscle of the duodenum bears a worse prognosis. PPPD is an attractive alternative to the Whipple operation for ampullary cancer because no involvement was found in the tissue preserved by the PPPD. However, surgeons should be aware of a concomitant gastric cancer when doing a PPPD.

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Resumen Existe controversia sobre la aplicación de la pancreatoduodenectomía con preservación del píloro (PPPD) en el manejo de los neoplasmas malignos. El presente estudio estuvo orientado a establecer el patrón de extensión del cáncer ampular y a comprobar si la extensión tumoral en las etapas resecables no afecta los tejidos que se preservan en una PPPD. Revisamos 40 especímenes de pancreatoduodenectomías de Whipple consecutivas: cáncer mucoso, 4 casos; cáncer que invadía (pero no penetraba) el esfinter de Oddi, 1; cáncer que invadía la submucosa del duodeno, 12; cáncer que invadía la capa muscular del duodeno, 5; cáncer que invadía la capa subserosa del duodeno, 7; y cáncer que invadía el parenquima pancreático, 11. Cinco casos de cáncer mucoso o de cáncer que invadía (pero no penetraba) el esfinter hicieron extensión local sin invasión ganglionar y exhibieron una tasa de sobrevida a cinco años de 80% sin recurrencia, siendo mejor (p<0.05) que la tasa de 40% de sobrevida en los casos más avanzados. Sesenta y tres por ciento de los otros 35 casos presentaban metástasis a los ganglios regionales. La tasa de sobrevida a cinco años de 28% en aquellos tumores que penetraban la capa muscular fue peor (p<0.05) que la tasa de 59% en los tumores menos avanzados. Ninguno de los casos presentaba invasión de las estructuras anatómicas que habrían sido preservadas en una PPPD. En 3 casos (7.5%) coexistía cáncer gástrico. En conclusión, el cáncer ampular que no penetra el esfínter se extiende localmente. Una vez que ha penetrado el esfínter, generalmente se extiende en forma regional y causa recurrencias. El cáncer que penetra la capa muscular del duodeno conlleva un peor pronóstico. La PPPD es una atractiva alternativa a la operación de Whipple para el cáncer ampular, puesto que no se halló invasión de los tejidos que se preservan en la PPPD. Sin embargo, los cirujanos deben estar conscientes de la posibilidad de un cáncer gástrico concomitante cuando realicen PPPD.

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Résumé L'indication de la duodénopancréatectectomie avec conservation du pylore (DPCP) est controversée du point de vue carcinologique. Cette étude avait pour but d'analyser le mode de propagation des tumeurs ampullaires et de vérifier que les tissus laissés en place par la DPCP ne contenaient pas d'extension cancéreuse. Nous avons examiné 40 pièces consécutives de duodénopancréatectomie pour cancer de la muqueuse (n=4), pour cancer envahissant (mais non pénétrant) le sphincter d'Oddi (n=1), pour cancer envahissant la couche sous muqueuse du duodénum (n=12), pour cancer envahissant le muscle propre du duodénum (n=5), pour cancer envahissant la couche sousséreuse du duodénum (n=7) et pour cancer envahissant le parenchyme pancréatique (n=11). Cinq cas de cancer de la muqueuse ou de cancer envahissant (mais non pénétrant) le sphincter, étendu localement sans métastases lymphatiques, ont une survie à 5 ans de 80% sans récidive, survie meilleure (p<0.05) que celle observée lorsque le cancer est plus avancé (40%). Soixante-trois pour-cent des 35 tumeurs restantes avaient des métastases lymphatiques régionales. La survie à 5 ans des 28 pour-cent des patients ayant un cancer pénétrant le muscle propre était pirc (p<0.05) que la survie des 59 pour-cent des patients ayant une tumeur moins avancée. Il n'y avait aucun envahissement des tissus qui auraient été conservés dans une DPCP. Dans trois cas (7.5%), il existait un cancer gastrique concomitant. En conclusion, le cancer ampullaire qui ne pénètre pas le sphincter se propage localement. Les cancers pénétrant le muscle propre du duodénum sont associé à un plus mauvais pronostic. La DPCP est une alternative attractive à la duodénopancréatectomie pour le cancer ampullaire car les tissus laissés en place ne sont pas envahis par ces cancers. Il faut être averti, cependant, de la possibilité de cancer gastrique associé.

     

A clinical study on the R-R interval on ECG in urethral syndrome

We reviewed 41 patients who were evaluated for the urethral syndrome. Evaluation included urinalysis, cystoscopy and the measurement of the R-R interval on ECG in all cases. The coefficient variation of R-R interval in urethral syndrome was significantly lower (p less than 0.001) than that of the healthy individuals. Treatment by mecobalamin showed that 4 of the 6 patients benefitted considerably.