Lower urinary tract dysfunction in type 1 familial amyloidotic polyneuropathy in Kumamoto, Japan

OBJECTIVE: To evaluate lower urinary tract dysfunction of type 1 familial amyloidotic polyneuropathy (FAP) patients in Kumamoto, Japan. METHODS: Lower urinary tract symptoms were evaluated in FAP patients. Urodynamic studies were evaluated in FAP patients as compared to those in control subjects. The location and distribution of amyloid deposits were evaluated in the urinary bladder in an autopsy case. RESULTS: In lower urinary symptoms, 86%, 19% and 38% patients showed difficulty in urination, urinary frequency and urinary incontinence. In detrusor function during filling cystometry, 14% patients showed detrusor overactivity. Moreover, 43% patients showed low compliance bladder, 62% and 38% patients showed normal and reduced bladder sensation, respectively. First desire to void (FDV), strong desire to void (SDV) and post-voided residual urine (PVR) were increased in FAP patients as compared to those in control subjects. In the urethral pressure profilometry, 71%, 10% and 19% patients showed incompetent, normal functional and overactive urethral closure mechanism, respectively. Maximum urethral pressure (MUP), maximum urethral closure pressure (MUCP) and functional profile length (FPL) were decreased in FAP patients compared to those in control subjects. CONCLUSION: Autonomic, somatic nerve systems and bladder detrusor musculature might be impaired in lower urinary tract of type 1 FAP patients in Kumamoto, Japan.     

Distribution of Successful Ablation Sites of Idiopathic Right Ventricular Outflow Tract Tachycardia

Background: There are few studies evaluating the distribution of successful ablation sites of idiopathic right ventricular outflow tract (RVOT) arrhythmias using a three-dimensional electroanatomical mapping system. This study aims to clarify the favorite site of idiopathic RVOT arrhythmias through electroanatomical voltage mapping using the CARTO system (Biosense Webster, Diamond Bar, CA, USA).
Methods: A consecutive series of 72 patients (mean age 43.6 ± 16.2 years, 32 males) who underwent radiofrequency catheter ablation (RFCA) for a total of 82 morphologies of idiopathic RVOT arrhythmias were studied. Detailed three-dimensional electroanatomical voltage maps of the RVOT were obtained using the CARTO system prior to the RFCA during sinus rhythm. The voltage on bipolar electrogram was defined as follows: amplitude < 0.5 mV as "low-voltage zone," amplitude between 0.5 and 1.5 mV as "transitional-voltage zone," and amplitude >1.5 mV as "high-voltage zone." Successful ablation sites were electroanatomically classified into each voltage zone.
Results: Successful ablation was acquired in 63 patients and 71 RVOT arrhythmias (63/72 patients: 87.5%, 71/82 RVOT arrhythmias: 86.5%). In the successful group, three arrhythmias (4.2%) were classified in the low-voltage zone, 63 arrhythmias (88.7%) in the transitional-voltage zone, and five arrhythmias (7.0%) in the high-voltage zone.
Conclusions: This study indicates that the vast majority of successful ablation sites for idiopathic RVOT arrhythmias are located in the transitional-voltage zone. Mapping of the transitional-voltage zone may be an important landmark of RFCA for RVOT arrhythmia.     

IFNγ调控人肺癌A549细胞Fas／FasL表达对T淋巴细胞生长的影响

为探讨IFNγ调控有肺癌细胞Fas/FasL表达对T细胞生长的影响，分别采用FACScan,RT-PCR方法检测Fas/FasL蛋白质及mRNA表达；以荧光染色及FACScan法观察细胞凋亡；用苔酚兰排除实验分析细胞生长。结果表明，人肺癌细胞A549及T－细胞系（Jurkat)均有Fas及FasL表达；IFNγ可引起A549Fas表达上调，且与剂量相关，并增加了A549细胞凋亡诱导的敏感性；A549细胞与Jurkat细胞共培养实验证明：人A549细胞通过Fas/FasL介导导致Jurkat细胞生长抑制及凋亡诱导；IFNγ处理A549细胞后，减少了其对Jurkat细胞的生长抑制。上述结果提示：Fas/FasL途径介导了A549细胞与Jurkat细胞之间的凋亡，IFNγ通过对人肺癌细胞Fas/FasL系统表达调控，使A549细胞自身对凋亡诱导的敏感性增加，并对T细胞生长的抑制作用减弱，提示IFNγ在防止肿瘤细胞逃避免疫监控有一定作用。     

Neural substrates of emotional habituation: A PET study using film stimuli

Abstract  While external stimuli are given repeatedly, the level of emotional response gradually decreases. This study aims to reveal the neural substrates of such emotional habituation. Fifteen healthy male volunteers were examined using [¹⁵O]-H₂O-PET scanning. Subjects were required to watch two film clips, a horror scene (emotional task) and a calm scene (non-emotional task). Each film clip was repeatedly presented six times during 12 PET scans. The regional cerebral blood flow (rCBF) in the first two scans of each task was compared with that in the last two scans. On the emotional task, the right retrosplenial cortex (Brodmann's areas 30 and 23) was activated during the former scans, and the bilateral occipital cortices (BA19 and 37) were activated during the latter scans. As for the non-emotional task, the bilateral occipital cortices (BA19 and 37) were activated during the first two scans, and the bilateral prefrontal cortices (BA10) were activated during the last two scans. The activated cerebral region by emotional experience reciprocally transferred from the paralimbic region (the retrosplenial cortex) to the neocortical region (the bilateral occipital cortices) as the experience was repeated. This finding is consistent with the theory that the process of emotional habituation is promoted by the process of conceptualization.     

Physical and socioeconomic predictors of birthweight in Japan

BACKGROUND: The purpose of this study was to characterize physical and socioeconomic factors associated with birthweight in Tokyo, Japan. METHODS: In a cohort of obstetric outpatients from the Tokyo Metropolitan Maternity and Child Health Institute, Tokyo, and The Jikei University School of Medicine, Chiba, Japan, 553 eligible women in their third trimester of pregnancy were given a survey investigating physical and socioeconomic backgrounds. RESULTS: Infants tended to be small for gestational age when maternal pre-pregnancy weight was lower, and low income and female infant gender were significantly associated with a low birthweight infant. Further, birthweight compared with predicted birthweight was lower in the case of a female infant gender, low income, low maternal pre-pregnancy weight and low parity. CONCLUSION: Income is a novel parameter that is associated with birthweight in Japan.     

CT examination of the manipulation system in the giant panda (Ailuropoda melanoleuca)

The manipulation mechanism of the giant panda ( Ailuropida melanoleuca ) was examined by means of CT (computed tomography) and 3-dimensional (3-D) Volume Rendering techniques. In the 3-D images of the giant panda hand, not only the bones but also the muscular system was visualised. Sections of the articulated skeleton were obtained. It was demonstrated that the hand of the panda is equipped with separately moulded manipulation units as follows: (1) the radial sesamoid (RS), the radial carpal, and the first metacarpal (R–R–M) complex; and (2) the accessory carpal (AC) and the ulnar (A–U) complex. When the giant panda grasps anything, the R–R–M complex strongly flexes at the wrist joint, the RS becomes parallel with the AC, and the phalanges bend and hold the object. It is shown that the well-developed opponens pollicis and abductor pollicis brevis muscles envelop and fix the objects between the R–R–M complex and the phalanges during grasping.     

Alpha-blocker test: Alternative to pressure–flow study of bladder outlet obstruction and detrusor contractility in patients without an enlarged prostate

OBJECTIVES: We investigated whether the cause of urinary disturbance in men with a prostate volume < or =20 mL can be determined by analyzing the efficacy of alpha1-adrenoceptor antagonist (alpha-blocker) treatment. METHODS: Thirty-five men who were >50 years of age, with an International Prostate Symptom Score (IPSS) > or =8 points, a quality of life (QOL) index > or =2 points and a prostate volume 20 mL served as controls. The alpha1-adrenoceptor antagonist tamsulosin was administered at a dose of 0.2 mg/day for 4 weeks. Results for the IPSS, QOL index, free flowmetry and pressure-flow studies were obtained before and after tamsulosin administration. RESULTS: In both groups, tamsulosin improved the IPSS and QOL index and the bladder outlet obstruction index (BOOI) was lowered without reducing the bladder contractility index (BCI). No parameter showed a significant difference in treatment efficacy between the two groups. In the non-enlarged prostate group, both the pretreatment BOOI and BCI correlated with the efficacy of treatment in improving maximum flow rate (Qmax). In the enlarged prostate group, BOOI and BCI did not correlate with Qmax. When Qmax was improved by > or =3.5 mL/s, the positive predictive value for both pretreatment BOOI >40 and BCI >100 was 100% in the non-enlarged prostate group. CONCLUSIONS: The alpha-blocker test is one method to assess the presence of bladder outlet obstruction and the state of detrusor contractility in men without an enlarged prostate.     

Convulsions associated with epidural analgesia during sevoflurane anaesthesia

A three-year-old girl who underwent an operation for adrenal neuroblastoma was anaesthetized with sevoflurane and epidural analgesia. In the immediate recovery period she had convulsions. The convulsions were successfully treated with thiopentone and sevoflurane, there were no neurological sequelae. The convulsions were considered to be a manifestation of mepivacaine toxicity because of a high plasma mepivacaine concentration. Complications of paediatric regional analgesia and manifestations of mepivacaine toxicity under sevoflurane anaesthesia are discussed.     

An early-onset case of multiple sclerosis with thalamic lesions on MRI

We present here an early-onset case of multiple sclerosis (MS) with thalamic lesions. The patient first experienced an episode of ataxic gait at 2 years 3 months of age, with spontaneous remission within 1 month. At 5 years 4 months, she was admitted because of cerebellar ataxia, oculomotor restriction and feeding difficulty. Magnetic resonance imaging (MRI) showed multiple well-defined lesions in the white matter of the cerebellum, mid-brain, periventricle and right frontal lobe. Cerebrospinal fluid (CSF) showed a mild elevation of both immunoglobulin G (IgG) and myelin basic protein (MBP). Serum anti-myelin antibody was also positive, although leukocytosis and elevation of C-reactive protein were not found. Methylprednisolone pulse therapy relieved symptoms within 2 weeks and the abnormal MRI and CSF findings gradually improved. At 6 years 6 months of age, she incurred a third episode of cerebellar ataxia and disturbance of consciousness. Magnetic resonance imaging revealed recurrence and extension of the previous lesions as well as new lesions in the thalamus and internal capsule. CSF IgG and MBP level showed a higher elevation than in the second episode. The combination of the cerebellar, brain-stem, cerebral and thalamic lesions with remission and exacerbation, supported by MRI and CSF findings, allowed the diagnosis of clinically definite MS to be made. This is one of the youngest cases of MS yet described, with the first attack occurring at 27 months of age. In addition, this case is unique for the involvement of the gray matter in the thalamus.     

A case of bacterial meningitis complicated by posttraumatic cerebrospinal fluid rhinorrhea

This paper reports an 11 year old boy with bacterial meningitis accompanied by post-traumatic cerebrospinal fluid (CSF) rhinorrhea. Streptococcus pneumoniae was cultured from CSF. The clinical course was very rapid before admission and his age relatively high for usual bacterial meningitis. Consequently, we examined the cause in detail. Immunological findings were within normal limits. Although routine graphic examinations, such as cranial X-ray photography, horizontal cranial computed tomography (CT) and magnetic resonance imaging, could not demonstrate a bone defect, both coronal thin-section cranial CT scanning and radioactive isotope counting by means of cotton packed into the nasal cavity were useful for detecting CSF rhinorrhea. In a case of atypical meningitis, the past history should be examined with caution and coronal thin-section CT should be performed.