Transient encephalopathy with reversible white matter lesions in children

We report on two children with acute encephalopathy showing mild clinical manifestations and reversible white matter lesions. In both patients, MRI revealed high intensities on T (2)-weighted imaging and marked reductions of water diffusion in the white matter of the bilateral centrum semiovale and the corpus callosum. These abnormalities disappeared along with the neurological symptoms within a week in both patients. These children represent a characteristic group of patients among childhood acute encephalopathy.     

Amelioration of acute graft-versus-host disease by NKG2A engagement on donor T cells

Acute graft-versus-host disease (aGVHD) remains a major complication of allogeneic bone marrow transplantation, which is caused by donor T cells specific for host alloantigens. In a murine model, we found that donor T cells expressed a natural killer cell inhibitory receptor, CD94/NKG2A, during the course of aGVHD. Administration of an anti-NKG2A mAb markedly inhibited the expansion of donor T cells and ameliorated the aGVHD pathologies. These results suggested that the CD94/NKG2A inhibitory receptor expressed on host-reactive donor T cells can be a novel target for the amelioration of aGVHD.     

The odontoblast as a sensory receptor cell? The expression of TRPV1 (VR-1) channels

Previous reports have shown the expression of several mechanosensitive ionic channels on the plasma membrane in odontoblasts, which are the cells responsible for dentin formation. The membrane characteristics of odontoblasts imply that they could play critical roles in the mechano-transduction of fluid displacement within dentinal tubules into the electrical cell signals, to carry dentin sensation to the central nervous system. However, the direct ionic mechanism underlying such a dentin nociceptive function remains unclear. In the present study, we investigated the expression of the transient receptor potential vanilloid subfamily member 1 (TRPV1) channel - which essentially contributes to the detection of pain sensation - in rat odontoblasts by immunohistochemical and nystatin perforated patch-clamp techniques. Immunohistochemical observation showed the localization of TRPV1-immunoreactions on the distal regions of odontoblast membranes. In the patch-clamp experiments, we observed capsaicin-induced inward currents that were inhibited by capsazepine, a TRPV1 channel antagonist. Our results indicate a significant expression of TRPV1 channels in odontoblasts, suggesting that odontoblasts may directly respond to noxious stimuli such as a thermal-heat stimulus, and point to the necessity for a reconsideration of the cellular mechanisms of dentin sensation based on the transmembrane ionic signals in odontoblasts.     

Cyclosporin A absorption profiles in children with nephrotic syndrome

A single blood concentration measurement of Neoral 2 h after administration (C2) is a new concept in therapeutic drug monitoring (TDM). In most adult patients, the concentration of cyclosporin A (CyA) peaks within 2 h after Neoral administration. Therefore, monitoring the area under the concentration-time curve over the first 4 h post-dose (AUC0–4) is considered to be the most reliable strategy for Neoral TDM. In addition, C2 is considered to be the most accurate predictor of AUC0–4, with which C2 correlates best. Thus, in adult patients, C2 monitoring is recommended as the best single-point TDM method for Neoral. However, in paediatric patients, the effectiveness of C2 monitoring is still unclear. We examined the trough concentration (C0), C1, C2, C3, and C4 of CyA in 60 patients (1 to 20 years old, mean age 7.42±0.67 years) who had nephrotic syndrome treated with Neoral. The peak concentration of C0-C4 was C1 or C2 in 38 patients (early peak group) and C3 or C4 in 22 patients (late peak group). C2 in the late peak group was significantly lower than that in the early peak group (422±50.1 vs. 665 ±53.8 ng/ml, P =0.0008), although the administered doses of Neoral and C0 were similar between these groups. Therefore, TDM by C2 using the same standard as in the early peak group might result in an overdose of CyA in the late peak group. As the concentration peaked at 3 h or more after Neoral administration in the late peak group, AUC0–4 does not necessarily reflect the Neoral absorption profile. As more than 33% of the paediatric patients were in the late peak group, TDM by AUC0–4 or C2 should be used carefully in paediatric patients treated with Neoral.     

Comparison of Tc-99m-GSA scintigraphy with hepatic fibrosis and regeneration in patients with hepatectomy

OBJECTIVE: Liver regeneration after hepatectomy is correlated with liver fibrosis. Retrospectively, we compared three quantitative indices (HH15, LHL15 and LU15) of Technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin (Tc-99m-GSA) liver scintigraphy with liver fibrosis; in particular, we compared the HH15 index and the rate of remnant liver regeneration. METHODS: Fifty-three patients who had undergone hepatectomy were enrolled in this study. The non-neoplastic parts of their resected specimens were divided into 5 groups (F0-F4) according to the degree of liver fibrosis, as determined using the New Inuyama classification system: F0, no fibrosis (n = 12); F1, portal fibrosis widening (n = 12); F2, portal fibrosis widening with bridging fibrosis (n = 14); F3, bridging fibrosis plus lobular distortion (n = 7); F4, liver cirrhosis (n = 8). RESULTS: When the cases were divided into a no or mild fibrosis group (F0 and F1) and a moderate or severe fibrosis or cirrhosis group (F2, F3 and F4), all of the indices were significantly different between the two groups. In this analysis, the areas (Az) under the receiver operating characteristic (ROC) curves for the HH15 and LHL15 indices were very similar, while the Az for the LU15 index was smaller. An HH15 index equal to 0.52 was the most accurate, producing a 79.3% sensitivity and a 75.0% specificity rating. When 18 patients that had received a CT scan one month after hepatectomy were divided into 2 groups according to their HH15 value (group A, HH15 < or = 0.52; group B, HH15 > 0.52), group A exhibited a better regeneration rate. CONCLUSION: Tc-99m-GSA scintigraphy is well correlated with liver fibrosis and may be useful for non-invasive, preoperative evaluations of liver fibrosis. The HH15 index, in particular, may be useful for predicting the rate of liver regeneration after hepatectomy.     

Artificially produced meteorological changes aggravate pain in adjuvant-induced arthritic rats

To examine the effects of change in meteorological parameters on pain-related behaviors in a simulated arthritic condition, rats with an injection of complete Freund's adjuvant into the tibio-tarsal joint were exposed to low barometric pressure (20 mmHg below the natural atmospheric pressure) and low ambient temperature (7 degrees C lower than 22 degrees C) in a climate-controlled room. When the arthritic rats were exposed to these environments, the already increased number of hindpaw withdrawals in response to noxious mechanical stimulation (hyperalgesia) was further increased, and a hindpaw withdrawal response to innocuous mechanical stimulation (allodynia) began to occur. Such exposures did not influence any of the pain-related behaviors of the control rats. These results show that lowering barometric pressure and ambient temperature within the range of natural environmental fluctuation intensify pain in arthritic rats.     

Day-care centre supplementary feeding effects on child nutrition in urban slum areas of Nepal

We compared the nutritional status of children aged 1-5 years from slums attending two day-care centres (DCCs) in Nepal (one in an urban slum area) with that of non-attendees to evaluate the impact of supplementary feeding. We measured the anthropometrics of 23 children attending two DCCs and 23 matched controls from the same neighbourhood and interviewed their mothers. We found a better nutritional status, particularly the height-for-age Z-score, among the attendees of the DCC with children's longer attendance, but no difference at the other, although attendees who had been fed for longer tended to show better nutrition. Our study indicates that in the least developed countries good quality day-care of sufficient duration has the potential to improve child nutrition.