Frequency of common bile duct motion artifacts caused by inferior vena cava pulsation on magnetic resonance cholangiopancreatography.

PURPOSE: We assessed the frequency of common bile duct (CBD) motion artifacts caused by inferior vena cava (IVC) pulsation on magnetic resonance cholangiopancreatography (MRCP). METHODS: We retrospectively evaluated CBD motion artifacts in 4 MRCP sequences from each of 115 consecutive patients. RESULTS: We observed 37 (32.2%) ghost artifacts at the ventral and dorsal aspects of the CBD on transaxial, half-Fourier acquisition single-shot turbo spin-echo (HASTE-ax) images; no such artifacts were observed on transaxial T(2)-weighted turbo spin-echo images. In 10 patients, we observed 9 (7.8%) pseudo-defects of the CBD on 3-dimensional T(2)-weighted turbo spin-echo with navigator-triggered prospective acquisition correction technique MRCP and 6 (5.2%) pseudo-defects on single-shot rapid acquisition with relaxation enhancement MRCP. Pseudo-defects were significantly more frequent in patients with ghost artifacts than without (9 of 37 [24.3%] versus one of 78 [1.3%]; P<0.01, McNemar test). CONCLUSION: Although uncommon, pseudo-defects of the CBD caused by IVC pulsation are observed on MRCP. MRCP interpretation that includes comparison with HASTE-ax images can diminish the potential misinterpretation of such CBD motion artifact as bile duct tumor or biliary stone.     

Monoclonal Antibody OKB19, Reactive with a B-Lymphoid Differentiation Antigen (CD19), Binding to Basal Layer Keratinocytes of Normal Human Skin

Monoclonal antibody (moAB) OKB19 reacts with CD19 antigen, which is the broadest lineage-specific surface marker on B-lymphocytes. In frozen tissue sections, using an immunohistochemical technique, the OKB19-positive cells in the basal layer were sharply demarcated from the negative suprabasal layers. In normal hair follicles, the OKB19 reactivity was also confined to one layer of the dermal side of the outer root sheath. However, this reactivity gradually disappeared in the lower areas. The inner surface of the lumina in the eccrine duct was weakly stained with OKB19. The basal keratinocytes were also stained with OKB19 in the lesional epidermis of the various dermatoses examined in this study, when the basal keratinocytes remained unaffected. Even in the hyperproliferative state of psoriasis, the OKB19 reactivity was confined to the basal layer. Several kinds of tumor cells derived from the skin were not stained with OKB19. No labeling was seen even in the basaloid cells of basal cell carcinoma, which are morphologically similar to basal keratinocytes. B4 and Leu-12, other monoclonal antibodies reacting with CD19, did not recognize any keratinocytes in the normal human skin. MoAB OKB19, therefore, reacts with an antigen present on basal keratinocytes and provides a probe for the isolation of the basal keratinocyte subpopulation. Thus, this antibody should be useful in studies of not only B-lymphocyte differentiation, but also normal and aberrant differentiation of the epidermal keratinocytes.     

High-risk populations for nasal carriage of methicillin-resistant Staphylococcus aureus

To determine the population at high risk of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) on hospital patients admission, a nasal swab was taken from the following patients: (1) those aged 70 years or over (age 70), (2) non ambulatory receiving regular home visits by nurses and physicians (visiting), (3) residents of nursing homes (nursing home), (4) patients from other hospitals (another Hp), and (5) those scheduled for surgery (presurgery). Between March and July 2000, a total of 412 patients were admitted and 136 were enrolled. MRSA was isolated from 12 (8.8%) patients. The number of patients positive for MRSA in the five groups, age 70, visiting, nursing home, another Hp, and presurgery, were 3 of 68, 3 of 21, 2 of 3, 3 of 9, and 1 of 35, respectively. Multivariate analysis revealed that living in a nursing home [odds ratio (OR) = 32.82, P = 0.010] or coming from another hospital (OR = 14.55, P = 0.0043) were high risk factors with for nasal carriage of MRSA. Furthermore, patients ages were further divided into three categories, 79, 80–89, 90, and regarded as independent high risk factors (OR = 3.08, P = 0.043). The results were that advanced living in a age (80, 90), living in a nursing home or coming from another hospital are high risk factors of nasal carriage of MRSA on hospital admission.     

Novel Ultrasonographic Scoring System of Sinusoidal Obstruction Syndrome after Hematopoietic Stem Cell Transplantation

Sinusoidal obstruction syndrome (SOS)/hepatic veno-occlusive disease (VOD) is a well-documented complication after hematopoietic stem cell transplantation (HSCT). Transabdominal ultrasonography (US) enables the visualization of blood flow abnormalities and is therefore useful for the diagnosis of SOS/VOD. We herein prospectively evaluated accuracy of a novel US diagnostic scoring system of SOS/VOD based on US findings. We carried out US in 106 patients on day 14 and when SOS/VOD was suspected after allogeneic HSCT. Among 106 patients, 10 patients (9.4%) were diagnosed as SOS/VOD by Baltimore or Seattle criteria. According to univariate analysis of 17 US findings (US-17 screening), we established a novel scoring system (HokUS-10) consisting of 10 parameters, such as gallbladder wall thickening, ascites, and blood flow signal in the paraumbilical vein. The sensitivity and specificity were 100% and 95.8%, respectively. Diagnostic performance of the HokUS-10 was significantly better than US-17 screening. In 4 of 10 patients US detection of SOS/VOD preceded to clinical diagnosis. The HokUS-10 scoring system is useful in the diagnosis of SOS/VOD; however, our results should be validated in other cohorts.     

Effect of persistent menopausal symptoms on the wellbeing of Japanese breast cancer survivors

While more women with breast cancer survive because of advances in cancer treatment including hormonal therapy, they are at a risk of menopausal symptoms, which can threaten their psychological wellbeing. We examined the effect of menopausal symptoms on women's psychological wellbeing during three different phases of breast cancer: short‐term (0–1 years since diagnosis), medium‐term (2–5 years), and long‐term (more than 5 years). In this cross‐sectional study, 425 survivors treated with hormonal therapy were recruited from a convenience sample in Japan and completed an anonymous self‐administered questionnaire. Multiple regression analysis revealed that menopausal symptoms significantly contributed to psychological wellbeing in all phases. In long‐term survivors, menopausal symptoms were significantly milder; however, the negative effect was prolonged. One in three to four survivors was suspected to have poor psychological wellbeing, irrespective of time. Although the effect of menopausal symptoms on psychological wellbeing has been described in short‐term survivors, little is known about the long‐term effect. This study examines the effect of menopausal symptoms on psychological wellbeing, thereby providing useful information regarding long‐term quality of life.     

Chronic administration of DSP‐7238, a novel,potent, specific and substrate‐selective DPP IV inhibitor,improves glycaemic control and β‐cell damage in diabetic mice

Aims: The purpose of this study is to assess the in vitro enzyme inhibition profile of DSP‐7238, a novel non‐cyanopyrrolidine dipeptidyl peptidase (DPP) IV inhibitor and to evaluate the acute and chronic effects of this compound on glucose metabolism in two different mouse models of type 2 diabetes. Methods: The in vitro enzyme inhibition profile of DSP‐7238 was assessed using plasma and recombinant enzymes including DPP IV, DPP II, DPP8, DPP9 and fibroblast activation protein α (FAPα) with fluorogenic substrates. The inhibition type was evaluated based on the Lineweaver–Burk plot. Substrate selectivity of DSP‐7238 and comparator DPP IV inhibitors (vildagliptin, sitagliptin, saxagliptin and linagliptin) was evaluated by mass spectrometry based on the changes in molecular weight of peptide substrates caused by release of N‐terminal dipeptides. In the in vivo experiments, high‐fat diet‐induced obese (DIO) mice were subjected to oral glucose tolerance test (OGTT) following a single oral administration of DSP‐7238. To assess the chronic effects of DSP‐7238 on glycaemic control and pancreatic β‐cell damage, DSP‐7238 was administered for 11 weeks to mice made diabetic by a combination of high‐fat diet (HFD) and a low‐dose of streptozotocin (STZ). After the dosing period, HbA1c was measured and pancreatic damage was evaluated by biological and histological analyses. Results: DSP‐7238 and sitagliptin both competitively inhibited recombinant human DPP IV (rhDPP IV) with K_i values of 0.60 and 2.1 nM respectively. Neither vildagliptin nor saxagliptin exhibited competitive inhibition of rhDPP IV. DSP‐7238 did not inhibit DPP IV‐related enzymes including DPP8, DPP9, DPP II and FAPα, whereas vildagliptin and saxagliptin showed inhibition of DPP8 and DPP9. Inhibition of glucagon‐like peptide‐1 (GLP‐1) degradation by DSP‐7238 was apparently more potent than its inhibition of chemokine (C‐X‐C motif) ligand 10 (IP‐10) or chemokine (C‐X‐C motif) ligand 12 (SDF‐1α) degradation. In contrast, vildagliptin and saxagliptin showed similar degree of inhibition of degradation for all the substrates tested. Compared to treatment with the vehicle, single oral administration of DSP‐7238 dose‐dependently decreased plasma DPP IV activity and improved glucose tolerance in DIO mice. In addition, DSP‐7238 significantly decreased HbA1c and ameliorated pancreatic damage following 11 weeks of chronic treatment in HFD/STZ mice. Conclusions: We have shown in this study that DSP‐7238 is a potent DPP IV inhibitor that has high specificity for DPP IV and substrate selectivity against GLP‐1. We have also found that chronic treatment with DSP‐7238 improves glycaemic control and ameliorates β‐cell damage in a mouse model with impaired insulin sensitivity and secretion. These findings indicate that DSP‐7238 may be a new therapeutic agent for the treatment of type 2 diabetes.     

Development and prevention of morphologic and ultrastructural changes in uremia-induced hyperplastic parathyroid gland

The detailed ultrastructural changes of uremia-induced hyperplastic parathyroid gland and the effects of current medical treatments for secondary hyperparathyroidism were investigated. Marked enlargement of parathyroid cell with accumulation of mitochondria and lipids and a significant increase in the thickness of the pericapillary area with increased fibrosis and appearance of fibroblast like cells were noted in the hyperplastic gland caused by uremia and phosphate retention. These ultrastructural changes and biochemical findings indicating hyperparathyroidism were significantly suppressed by all of the treatment using phosphate restriction, calcitriol, and cinacalcet. The characteristic ultrastructural changes, including the morphologic evidence of nodule formation, were indicated.     

Development of multiplex short tandem repeat (STR)-PCR for chimerism analysis in patients with hematological malignancies and comparison of chimerism in different sample sources

Polymerase chain reaction analysis of short-tandem repeat (STR) markers (STR-PCR) has been used for chimerism testing to assess engraftment following hematopoietic stem cell transplantation (HSCT). We investigated the informativity of 7 STR loci (FGA, D5S818, SE33, TH01, VWF, PentaE, and D18S51) in 82 pre-HSCT DNA samples from 41 donor/recipient pairs and developed 2 multiplex STR-PCRs using VWF, SE33, and D18S51, D5S818 and FGA, respectively. The multiplex STR-PCRs could distinguish the recipients and donors in 92.7% of the cases. Dilution experiments using mixed DNA showed that the sensitivity of the multiplex STR-PCRs for detecting the minor population was 1-5%. To compare chimerism in different samples such as peripheral blood, mononuclear cells (MNC), and CD3-positive cells (CD3+), we investigated the relationship between the chimerisms at approximately day 30 post-HSCT and the interval from the day of HSCT to achievement of complete chimerism (CC) in 70 patients undergoing HSCT. CC was found in all samples of 54 patients at day 30 post-HSCT, and these samples showed CC thereafter. Eleven patients with mixed chimerism (MC) in all samples or in MNC and CD3+ showed CC at day 60-270 post-HSCT or persistent MC. The remaining 5 patients with MC in only CD3+ showed CC at day 30-60 post-HSCT. Taken together, MNC which can be separated easily may be a useful source for detecting patients who require longer time to achieve CC and those with high risk of graft failure.     

Usefulness of transesophageal echocardiography for identifying the precise location of a left ventricular rupture in a patient with collapsed cardiac chamber

We report an emergent case of cardiac tamponade due to rupture of the left ventricle. Preload and intracardiac volume were decreased by percutaneous cardiopulmonary support (PCPS), which led to the collapse of the cardiac chamber. The collapsed cardiac chamber made it difficult to diagnose cardiac abnormalities by preoperative transthoracic echocardiography (TTE). On loading fluid infusion and transfusion as volume load to improve the hemodynamic status, transesophageal echocardiography (TEE) revealed several leakages in the left ventricular myocardium. Continuous careful observation on TEE led us to a confident diagnosis of left ventricular rupture. The diagnosis by TEE also led to the employment of the appropriate procedure. TEE is useful for detecting an abnormality due to the location of the cardiac chamber and echocardiographic probe. We also note that continuous careful observation led to the employment of the appropriate procedure.