Differences in uterine artery blood flow and fetal growth between the early and late onset of pregnancy-induced hypertension

Purpose

We continuously measured bilateral uterine artery (UA) blood flow and compared differences in UA blood flow to investigate the differences in pathophysiology between early- and late-onset pregnancy-induced hypertension (PIH) and the usefulness of continuous monitoring of UA blood flow for the prediction of early-onset PIH.

Methods

The subjects were 76 PIH patients. The mean pulsatility index of bilateral UA (UAPI), an early diastolic notch in the velocity waveform, and regression curves were retrospectively examined and compared between early- and late-onset groups and the groups with and without fetal growth restriction (FGR).

Results

Regression curves of the UAPI in the early-onset group persisted at +2.0 standard deviations or more from the second to third trimester, while the UAPI in the late-onset group stayed within the normal range. A significantly higher mean UAPI with a high frequency of an early diastolic notch was observed in the early-onset group compared with the late-onset group in all pregnancy trimesters. There was a significant difference in UA resistance between the mild and severe groups and between the FGR and non-FGR groups, but to a small extent compared with the onset period.

Conclusion

There was a difference in pathophysiology between early- and late-onset PIH. Continuous monitoring of UA blood flow might be useful for the prediction of early-onset PIH if high UA resistance has been observed.

     

Effect of exercise training on plasma high-density lipoprotein cholesterol level at constant weight

Summary. Previous investigations have demonstrated an increase of plasma high-density lipoprotein cholesterol (HDL-Chol) and a decrease in the ratio of low density lipoprotein (LDL)-Chol/HDL-Chol (Atherogenic Index; AI) as a result of exercise training. The question of whether elevation of HDL-Chol was a consequence of weight reduction or physical training itself was unsolved. The present study was designed to prevent the weight reduction that is associated with exercise training. Five healthy and mildly active male volunteers, aged 28–31 years, participated in a 4-week training programme. They ran on a treadmill at 140–160 m/min at 0% grade for 50 min, 5 times a week, equivalent to an energy expenditure of 9 kcal/kg body weight/day. Subjects maintained their body weights by increasing calorie intake to match increased energy expenditure. No changes were observed in mean body weight, skinfold thickness, basal metabolism, and maximal oxygen uptake after the training programme. The HDL-Chol level increased from 54 to 73 mg/dl (P < 0.05), and the reduction of A1 was 30.8% (P < 0.05) in response to the exercise training. However, the exercise training did not induce changes in plasma total cholesterol and triglyceride (TG) levels. The results of this experiment suggested that moderate physical training itself can be a potent factor for the regulation of HDL-Chol level and improvement of the A1 in the absence of alterations in body weight.     

Brugada syndrome occurring after autologous peripheral blood stem cell transplantation for acute myeloid leukemia

A 74-year-old male was found to be suffering from the Brugada syndrome after undergoing high dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ABSCT) for acute myeloid leukemia. A specific ECG pattern of right bundle-branch block and a coved-type ST-segment elevation in leads V1 through V3, which is compatible with the Brugada syndrome, was unmasked by febrile neutropenia on the 8th day after ABSCT. He experienced syncope on the 11th day due to ventricular tachycardia, which was immediately improved with the administration of intravenous lidocaine. The Brugada syndorome should be considered in febrile patients if they have a episode of syncope or ECG change.     

A case of interstitial cystitis accompanying Sjögren’s syndrome

A 51-year-old woman with interstitial cystitis was referred for screening of autoimmune disease. She was positive for results of Schirmer and Saxon tests and for ss/A and ss/B antibodies. Autoantibodies to type 3 muscarinic acetylcholine receptor were detected in the patients serum by Western blotting. We diagnosed her as having interstitial cystitis accompanying Sjögrens syndrome. To enable early treatment, interstitial cystitis should be considered when patients with Sjögrens syndrome complain of urinary symptoms.     

PDC-TREM, a plasmacytoid dendritic cell-specific receptor, is responsible for augmented production of type I interferon

Type I interferons (IFNs) derived from plasmacytoid dendritic cells (PDCs) are critical for antiviral responses; however, the mechanisms underlying their production remain unclear. We have identified a receptor, PDC-TREM, which is associated with Plexin-A1 (PlxnA1) on the PDC cell surface and is preferentially expressed after TLR-stimulation. Limited TLR signals induced PDC-TREM expression but failed to induce IFN-alpha production. However, when coupled with Sema6D, a ligand for Plexin-A1, limited TLR-stimulation resulted in PDC-TREM-mediated DAP12-dependent phosphorylation of phosphoinositide 3-kinase (PI3K) and extracellular regulated kinase (Erk) 1/2 at 6-9 h, and IFN-alpha was produced. Inhibition of PDC-TREM expression by pdctrem-shRNA, blocking of PDC-TREM-binding with PlxnA1 by PDC-TREM mAb, and DAP12 deficiency all resulted in greatly reduced PDC-TREM-dependent activation of signaling molecules and IFN-alpha production. Thus, PDC-TREM is responsible for IFN-alpha production, whereas TLR signals are essential for PDC-TREM expression.     

Periarteriolar-Sparing Retinal Edema in Acute Central Retinal Artery Occlusion

A 56-year-old man was referred to our hospital about 48 h after sudden onset of painless central visual loss in his right eye (OD) on a winter morning. He had a more than 25-year history of systemic hypertension and smoking. Funduscopic observation showed striated retinal whitening in the macular region, faint cotton-wool patches around the optic disc, and segmental narrowing of the retinal arteries near the optic disc edge. Based on the pattern of onset and fundus findings, he was diagnosed with vasospastic acute central retinal artery occlusion OD, and a venous drip injection of prostaglandin E1 was started immediately. Optical coherence tomography showed bands of high and low density in the inner retina arranged alternately in the edematous area; the bands corresponded to edematous and nonedematous areas, respectively, and geographically to venules and arterioles, respectively. The best-corrected visual acuity of 0.03 at referral improved to 0.5, and the striated retinal edema and most cotton-wool patches resolved 1 month after onset. The oxygen pressure gradient in the capillary networks due to differences in the distance from the arterioles may be the mechanism of this unique periarteriolar-sparing retinal edema pattern.Key Words: Central retinal artery occlusion, Periarteriolar-sparing retinal edema, Prostaglandin E1, Spectral-domain optical coherence tomography     

All‐cause mortality increased by environmental cadmium exposure in the Japanese general population in cadmium non‐polluted areas

The aim of the present study was to evaluate the effect of environmental cadmium (Cd) exposure indicated by urinary Cd on all‐cause mortality in the Japanese general population. A 19‐year cohort study was conducted in 1067 men and 1590 women aged 50 years or older who lived in three cadmium non‐polluted areas in Japan. The subjects were divided into four quartiles based on creatinine adjusted U‐Cd (µg g^?1 cre). The hazard ratio (HR) and 95% confidence interval (CI) for continuous U‐Cd or the quartiles of U‐Cd were estimated for all‐cause mortality using a proportional hazards regression.The all‐cause mortality rates per 1000 person years were 31.2 and 15.1 in men and women, respectively. Continuous U‐Cd (+1 µg g^?1 cre) was significantly related to the all‐cause mortality in men (HR 1.05, 95% CI: 1.02–1.09) and women (HR 1.04, 95% CI: 1.01–1.07). Furthermore in men, the third (1.96–3.22 µg g^?1 cre) and fourth quartile (≥3.23 µg g^?1 cre) of U‐Cd showed a significant, positive HR (third: HR 1.35, 95% CI: 1.03–1.77, fourth: HR 1.64, 95% CI: 1.26–2.14) for all‐cause mortality compared with the first quartile (<1.14 µg g^?1 cre). In women, the fourth quartile of U‐Cd (≥4.66 µg g^?1 cre) also showed a significant HR (1.49, 95% CI 1.11–2.00) for all‐cause mortality compared with the first quartile (<1.46 µg g^?1 cre).In the present study, U‐Cd was significantly associated with increased mortality in the Japanese general population, indicating that environmental Cd exposure adversely affects the life prognosis in Cd non‐polluted areas in Japan. Copyright © 2014 John Wiley & Sons, Ltd.     

Liver biopsy features of acute hepatitis C compared with hepatitis A,B, and non-A,non-B,non-C

ABSTRACT— The diagnosis of acute hepatitis C (AHC) often can only be suspected because current serologic tests remain negative for over 3 months. Because histologic features might provide useful clues, we reviewed 85 liver biopsy specimens from 85 patients with acute viral hepatitis, comparing 22 cases of AHC with 23 cases of acute hepatitis A (AHA), 30 cases of acute hepatitis B (AHB), and 10 cases of acute hepatitis non-A, non-B, non-C (AHNC). AHC was characterized by dense portal lymphoid aggregates (7 cases) and Poulsen-Christoffersen-type cholangitis (8 cases); these lesions were not found in any other type of acute viral hepatitis, and thus appeared to be diagnostic. Sinusoidal inflammatory infiltrates also were common in AHC, particularly in biopsy specimens obtained during the early phase of the disease. These inflammatory infiltrates did not appear to affect adjacent hepatocytes. Necrosis in AHC usually was spotty and accompanied by mixed inflammatory cells. In AHNC, necrosis was also spotty but, as an added feature, pigmented macrophages predominated in them. In AHA, necrosis was predominantly periportal, whereas in AHB, severe zone-3 necrosis predominated. Fatty changes were predominantly microvesicular; they were common in AHC but were also found in other groups. Collectively, the described histologic features allowed diagnosis of AHC in biopsy specimens with reasonable confidence. However, histologic findings failed to predict the prognosis in individual cases.     

Multifaceted analysis of Japanese cases of primary ciliary dyskinesia: Value of immunofluorescence for ciliary protein detection in patients with DNAH5 and DNAH11 mutations

Multifaceted analysis is recommended for the diagnosis of primary ciliary dyskinesia (PCD). A 31-year-old woman had situs inversus, bronchiectasis, family history of PCD, and compound heterozygous mutations in DNAH5. Her cilia were immotile. Defects in the outer dynein arms were revealed by transmission electron microscopy and loss of DNAH5 proteins in the entire length of axonemes using immunofluorescence (IF). A 17-year-old boy had bronchiectasis and heterozygous mutations in DNAH11. His cilia were motile with normal ultrastructure. The loss of DNAH11 proteins at the proximal region of cilia was revealed by IF. IF could be useful to support PCD diagnosis.