Effect of Lactobacillus johnsonii La1 on immune function and serum albumin in aged and malnourished aged mice

OBJECTIVE: Protein-energy malnutrition (PEM) is a serious nutritional problem that causes immune dysfunction in elderly people. Probiotic lactic acid bacteria may potentially modify immunity; however, there is little evidence to elucidate the influence of these bacteria on PEM in the elderly. METHODS: The immune modulation effects of lactic acid bacterium Lactobacillus johnsonii La1 (La1) were examined in aged mice and aged mice with PEM. Twenty-month-old male 57BL6/n mice (n = 28) were divided into four groups and received the following diet for 14 d: a complete diet (20% protein) without Lal (control) or with Lal or a low-protein diet (5% protein) to induce PEM, with or without La1. All mice were immunized with diphtheria toxin (DT) with alfacalciferol at 7 d and sacrificed 14 d after starting the experimental diets. RESULTS: Serum albumin concentrations and body weight, both of which were reduced by the low-protein diet, were ameliorated by La1 intake and were the same as in mice receiving the control diet. Anti-DT immunoglobulin (Ig) A in fecal extract was increased by La1 intake in mice receiving the complete and low-protein diets. Serum anti-DT IgA, IgG, splenocyte proliferation, and CD8(+) T cells were reduced by the low-protein diet and restored by La1 intake. CONCLUSION: La1 enhances intestinal IgA production and helps recover nutritional status and systemic immune responses in aged mice with PEM. It is possible that La1 may contribute to immune system recovery in immunocompromised hosts such as elderly humans with PEM.     

The regulation system of brain aromatase activity; effects of androgens on hypothalamic aromatase in the male rat

Recently, some studies have found the greatest aromatase activity in brain areas associated with sexual differention and sexual behavior, namely the hypothalamic and limbic structures. We studied the regulation of aromatase activity in the hypothalamic area of male rats, using a sensitive in vitro assay which measures the amount of 3H2O formed by tissue homogenates during the conversion of [1 beta-3H] androstenedione to estrogen. After castration, hypothalamic aromatase activity was significantly decreased (P less than 0.01), and seminal vesicle (SV) and prostate (PR) weights were also significantly decreased (P less than 0.01). Castrated male rats were given testosterone (T), 5 alpha-dihydrotestosterone (DHT), 5 alpha-androstane-3 alpha, 17 beta-diol (A3 alpha), 5 alpha-androstane-3 beta and 17 beta-diol(A3 beta) in various doses (200-1000 micrograms/day) for 10 days, and were given 600 micrograms/day T, DHT, A3 alpha and A3 beta for various durations (1-10 days). We found that T, DHT and A3 alpha but not A3 beta reversed the effects of castration on the hypothalamic aromatase activity. The order of this reversible effect of androgens was as follows: T greater than or equal to DHT greater than A3 alpha. T, DHT, A3 alpha and A3 beta increased SV and PR weights, and the order of this effect was as follows: DHT greater than T greater than A3 alpha much greater than A3 beta. We administered the antiandrogen (flutamide) to intact male rats (8 mg/day for 6 days). Flutamide decreased hypothalamic aromatase activity at the same level as that of castrated rats. Likewise, administration of both flutamide and T to castrated rats blocked the T-induced increase in hypothalamic aromatase activity and accessory sexual organ weight. From these results, we suggest that T, DHT and A3 alpha regulated hypothalamic aromatase activity, that T was the most effective of the androgens, and that was different from peripheral androgen target organs.     

The Impact of Postoperative Complications on Survivals After Esophagectomy for Esophageal Cancer

The aim of this study was to assess the impact of postoperative complications after esophagectomy on long-term outcome.The treatment of esophageal cancer has recently been improved; however, esophagectomy with thoracotomy and laparotomy carries considerable postoperative morbidity and mortality. The real impact of postoperative complications on overall survival is still under evaluation.A retrospective analysis was performed on patients with esophageal cancer who underwent esophagectomy with thoracotomy and laparotomy, with R0 or R1 resection between January 1997 and December 2012. Of 402 patients, we analyzed the following parameters 284 patients who could be followed up for over 5 years: stage of disease, neoadjuvant therapies, surgical approaches, surgical complications, postoperative medical complications, and overall and relapse-free survivals using medical records.Of the 284 patients, 64 (22.5%) had pneumonia, 55 (19.4%) had anastomotic leakage, and 45 (15.8%) had recurrent laryngeal nerve paralysis (RLNP). Pneumonia had a significant negative impact on overall survival (P = 0.035); however, anastomotic leakage and RLNP did not affect overall survival. Multivariate analysis revealed that the presence of pneumonia was predictive of poorer overall survival; the multivariate hazard ratio was 1.456 (95% confidence interval 1.020–2.079, P = 0.039).Pneumonia has a negative impact on overall survival after esophagectomy. Strategies to prevent pneumonia after esophagectomy should improve outcomes in this operation.     

Effects of beraprost sodium,a new prostaglandin I2 analog,on parameters of hemostasis,fibrinolysis, and myocardial ischemia in patients with exertional angina

Summary The purpose of this study was to investigate the effects of beraprost sodium, a stable prostacyclin analog, on the parameters of hemostasis, fibrinolysis, and myocardial ischemia in patients with exertional angina. Thirty-one patients with exertional angina who had significant organic coronary artery stenosis in at least one of the three major coronary arteries were selected. All patients underwent quantitative exercise thallium-201 emission computed tomography before and 1 month after 120 µg per day of beraprost sodium administration. Before exercise, blood samples were collected from 8:30 a.m. to 9:30 a.m. after the patients had been lying in bed undisturbed for at least 10 minutes. Plasma platelet factor 4 (PF4), fibrinopeptide A (FPA), tissue plasminogen activator antigen (t-PA), and plasminogen activator inhibitor-1 activity (PAI-1) were measured. There were no significant differences in exercise parameters on both exercise tests. However, both the extent and severity scores of ischemia were significantly aggravated (p<0.05 for both) during beraprost sodium administration. Plasma FPA levels decreased significantly during beraprost sodium administration (p<0.01). Likewise, plasma PF4 levels decreased significantly during beraprost sodium administration (p<0.05). As for plasma t-PA antigen levels, there was no significant difference before versus during beraprost sodium administration. Plasma PAI-1 activity levels decreased significantly during beraprost sodium administration (p<0.05). The results indicate that beraprost sodium has strong antithrombogenic properties. However, its aggravation of myocardial ischemia may limit clinical usage.     

Effects of dehydroepiandrosterone on gluconeogenic enzymes and glucose uptake in human hepatoma cell line, HepG2

Dehydroepiandrosterone (DHEA), the most abundant human adrenal steroid, improves insulin sensitivity and obesity in human and model animals. In a previous study, we reported that orally administered DHEA suppresses the elevated activities of hepatic gluconeogenic enzymes like glucose-6-phosphatase (G6Pase) in C57BL/KsJ-db/db mice. However, the molecular mechanisms by which DHEA ameliorates insulin resistance are not clearly understood. In the present study, we cultured the human hepatoma cell line HepG2 with DHEA and measured the enzyme activity and protein expression of G6Pase to investigate the direct effect of DHEA on glucose metabolism in hepatocytes. DHEA significantly suppressed both the activity and protein expression of G6Pase. Moreover, DHEA decreased the gene expression of G6Pase and phosphoenolpyruvate carboxykinase, both of which were maximal at 1 microM DHEA, whereas the mRNA level of glucose-6-phosphate translocase was unchanged. Furthermore, DHEA enhanced 2-deoxyglucose uptake, although its effect was much smaller than that of insulin. These results suggest that DHEA may act at multiple steps in the regulation of glucose metabolism in the liver.     

A combination of P wave electrocardiography and plasma brain natriuretic peptide level for predicting the progression to persistent atrial fibrillation: comparisons of sympathetic activity and left atrial size

Purpose

Development of atrial fibrillation (AF) is complexly associated with electrical and structural remodeling and other factors every stage of AF development. We hypothesized that P wave electrocardiography with an elevated brain natriuretic peptide (BNP) level would be associated with the progression to persistence from paroxysmal AF.

Methods

P wave electrocardiography such as a maximum P wave duration (MPWD) and dispersion by 12-leads ECG, heart/mediastinum (H/M) ratio by delayed iodine-123 metaiodobenzylguanidine scintigraphic imaging, left ventricular ejection fraction (LVEF), and left atrial dimension (LAD) by echocardiography, and plasma BNP level were measured to evaluate the electrical and structural properties and sympathetic activity in 71 patients (mean ± standard deviation, age: 67?±?13 years, 63.4 % males) with idiopathic paroxysmal AF.

Results

Over a 12.9-year follow-up period, AF developed into persistent AF in 30 patients. A wider MPWD (>129 ms) (p?=?0.001), wider P wave dispersion (>60 ms) (p?=?0.001), LAD enlargement (>40 mm) (p?=?0.001), higher BNP level (>72 pg/mL) (p?=?0.002), lower H/M ratio (≤2.7) (p?=?0.025), and lower LVEF (≤60 %) (p?=?0.035) were associated with the progression to persistent AF, and the wide MPWD was an independently powerful predictor of the progression to persistent AF with a hazard ratio (HR) of 5.49 [95 % confidence interval (CI) 2.38–12.7, p?<?0.0001] after adjusting for potential confounding variables, such as age and sex. The combination of wide MPWD and elevated BNP level was additive and incremental prognostic power with 13.3 [2.16–13, p?<?0.0001].

Conclusion

The wide MPWD with elevated BNP level was associated with the progression to persistent AF.     

Primary angiitis of the central nervous system mimicking dissemination from brainstem neoplasm: a case report

BACKGROUND: Diagnosis of PACNS is very difficult because of the variety of clinical manifestation, especially neurologic and MRI findings. We report the case of a 68-year-old woman with PACNS. CASE DESCRIPTION: Her clinical symptoms mimicked malignant brainstem neoplasm disseminated to third and fourth ventricles and cervical spinal cord. Brain biopsy could not be correctly diagnostic. In spite of a trial of high-dose steroids, repeated MRI showed an increasing number of lesions. Two weeks after surgery, she died of respiratory dysfunction. Postmortem examination suggested PACNS, after consideration of histories, laboratory and radiologic findings, and the lack of systemic disease. CONCLUSION: Although brain biopsy represents the gold standard measure, combination with several other examinations might be necessary to arrive at an early and definitive diagnosis. PACNS should be considered the differential diagnosis of intracranial tumors.     

Impact of network time-delay and force feedback on tele-surgery

Object

We have developed a robotic minimally invasive surgical system within a tele-surgery capability and conducted several times of tele-surgery experiments including Japan–Thailand and Japan–Korea tele-surgery experiments by using conventional network infrastructures. In these experiments, laparoscopic cholecystectomies have been successfully performed on pigs. On the other hand, repetitive task evaluation studies are also crucial for further studies on tele-surgery applications. Nowadays, task evaluations of tele-robotic system within network time-delay have been studied in past years by many researchers. These experiments have been mostly focused on simplified tasks such as a peg-in-hole task. However, most of surgical procedures in minimally invasive surgery are based on medical specific skills such as anatomical knowledge and past experiences of surgeons. From these perspectives, a trial experiment within two tasks including surgery oriented manipulations was conducted to study the impact of network time-delay and force feedback on tele-surgery.

Materials and methods

The experiment was conducted by using the minimally invasive surgical system. As the experimental setup, a research and development Internet, JGN2 (Japan Gigabit Network 2) was used as a network infrastructure, and two tasks were performed by 15 subjects including 5 medical doctors. The trial conditions were given by changing time-delay (on the both tasks) and force feedback (on the first task). The first task was configured to test a simple surgical procedure, which is commonly performed in a laparoscopy as translational motions of surgical tools. The subjects were instructed to touch four columns located on points of a square. The second task was configured to test integrated surgical procedures. The subjects were instructed to perform a part of suturing procedures by using the robotic bending forceps.

Results

In the first task, the completion time was increased approximately 50% by time-delay. By using force feedback, the applied force was decreased. However, the effectiveness of force feedback was not strongly shown in MD group. On the other hand, the effectiveness of the force feedback was strongly shown in the applied force on the tip of surgical tool in both MD and non-MD groups. In the second task, the adverse impact of time-delay was not strongly shown in MD group. From the analysis of the motion records found that a skill of experienced surgeons on “occlusion problem” could be related in the results. These results indicate that skilful operators on surgical procedures can overcome the adverse impact of time-delay by introducing their skills depending on required surgical tasks. However, the drawback of time-delay still remains concerning on safety issues. The effectiveness of the force feedback was strongly shown in the first task in terms of the applied force on the surrounding environment.

Conclusions

Force feedback is an essential technology for further applications of tele-surgery. In addition, the force feedback technology can be partially used for compensating the drawback of time-delay.